Kinderwunsch und Uterus myomatosus: Wann und wie behandeln?

Background: Fibroids (leiomyomas) are the most frequent benign uterine tumor in women of reproductive age. Besides clinical symptoms, such as bleeding disorders and lower abdominal pain, uterine fibroids can affect the fertility potential and are associated with a higher risk of miscarriage and pregnancy complications. Objectives: In which context and to what extent should uterine fibroids of different degrees of severity be treated in women desiring to have children? Material and methods: A selective narrative literature survey with discussion and assessment of current data including cohort and case control studies, expert opinions and systematic reviews about the necessity of treatment of leiomyomas in subfertile women. Results: The extent and invasiveness of treatment of leiomyomas in patients wishing to become pregnant depend on the patient's total reproductive situation as well as the location, size and number of uterine fibroids. Medicinal treatment is currently primarily indicated as preoperative therapy. Current evidence shows a superiority of myomectomy over the newer treatment interventions uterine artery embolization (UAE) and non-invasive magnetic resonance imaging-guided thermal ablation by high-intensity focused ultrasound (HIFU). Although there are no clear recommendations for treatment, UAE or HIFU can represent a possible treatment concept for selected women as a last resort. Conclusion: Because of the variety of available therapies an individual multimodal multistage procedure for women with uterine leiomyomas and a desire to have children is possible. The available therapy options must be discussed with the patient taking the risks, the complexity and the individual total reproductive situation into account. Further investigations to evaluate newer treatment interventions, such as UAE and HIFU are needed.