Endometrial Polyps and Subfertility

Abstract

Endometrial polyps are frequently seen in subfertile women, and there is some evidence suggesting a detrimental effect on fertility. How polyps contribute to subfertility and pregnancy loss is uncertain and possible mechanisms are poorly understood. It may be related to mechanical interference with sperm transport, embryo implantation or through intrauterine inflammation or altered production of endometrial receptivity factors. Different diagnostic modalities such as two-or three-dimensional transvaginal ultrasound, saline infusion sonography or hysteroscopy are commonly used to evaluate endometrial polyps with good detection rates. The approach of clinicians towards polyps detected during infertility investigations is not clearly known, and it is quite likely that there is wide variation amongst different groups. Most clinicians suggest hysteroscopy and polyp removal if a polyp is suspected before stimulation for in vitro fertilisation or a frozen embryo transfer cycle. However, the clinical evidence and benefit of different management options during assisted reproduction technology cycles are conflicting. Currently, there is insufficient evidence to recommend one particular option over others when a polyp is suspected during stimulation for in vitro fertilisation. A properly designed randomized controlled trial is needed to determine the best treatment option. In this article, we present the available evidence and our practice related to different diagnostic modalities and management options.

Hysteroscopy as an investigation tool in recurrent implantation failure in vitro fertilization

“… 10 - 13 Uterine masses like polyps and fibroids are known to affect the implantation in various ways, including increased uterine contractions, abnormal vascularization, and, especially, chronic inflammation. 14 - 16 In our study we found over 50% of the patients had polyps and fibroids after surgical removal.…”

Role of diagnostic hysterolaparoscopy in the evaluation of female infertility

“…The presence of polyp may hinder implantation and cause infertility. 13 In a study including 224 female infertility patients, pregnancy rates improved by 50% after polypectomy. 14 All cases of endometrial polyps found in our study underwent polypectomy.…”

Retained intrauterine sutures for 6 years

“…It is usually asymptomatic and identified during the routine workup of AUB and/or infertility. [ 7 ] If the sutures used during CS undergo inappropriate hydrolysis and absorption, the retained intrauterine sutures may cause intrauterine inflammations with subsequent AUB and/or infertility. [ 2 3 ]…”

“…This case report highlights that the retained intrauterine sutures may interfere with sperm transport and implantation and act as FB with subsequent intrauterine inflammation and infertility. [ 7 ] In addition, the presented case highlights the role of the hysteroscopy as the gold standard procedure for uterine cavity assessment in women presented with AUB and/or infertility. [ 8 ]…”