Hysteroscopic polypectomy without cycle cancellation in IVF cycles

Abstract

Endometrial polyps destroy the endometrial texture and play an important role in implantation failure. There is no consensus about the management of patients diagnosed with endometrial polyp in IVF cycles. In this study, nine patients who underwent assisted reproduction treatment cycles were diagnosed with endometrial polyps less than 1.5 cm by transvaginal ultrasonography. Eight patients were treated by long protocol and one patient was the recipient of an egg donation cycle. In all patients, polyp resection was performed through hysteroscopic polypectomy. Polypectomy was done during ovarian stimulation in the standard treatment cycles, and during hormone replacement therapy in the recipient of the egg donation cycle. The interval between polyp resection and embryo transfer was 2-16 days. Four patients achieved pregnancy (two twins, two singletons), four patients were unsuccessful, and one pregnancy was a blighted ovum. All of the successful pregnancies are still ongoing. There is a dilemma regarding the management of patients diagnosed with endometrial polyps in assisted reproduction treatment cycles. If polypectomy before embryo transfer in an IVF cycle is proven to be safe, then embryos will be transferred without cycle cancellation. This study included nine patients; further studies with more patients are required to confirm these findings.

Hysteroscopic polypectomy prior to infertility treatment: A cost analysis and systematic review

“…The studies related to IVF/ICSI outcomes were more heterogeneous in their design. Of the seven studies of interest, two had mismatched control groups 20,21 while another two were case series 22,23 and therefore were excluded from the analysis. The remaining three studies 24–26 had properly matched control groups and thus were included in the analysis.…”

Endometrial Polyps

“…Madani et al [ 78 ] reported on nine patients who were diagnosed with endometrial polyps <1.5 cm by TVUS while undergoing ART cycles and who underwent hysteroscopic polypectomy during ovarian stimulation in the standard treatment cycles. The interval between polyp resection and embryo transfer was 2-16 days.…”

Increasing Pregnancy by Improving Embryo Transfer Techniques

“…Endometrial damage by endometrial sampling (Barash et al, 2003) or hysteroscopic polypectomy (Varasteh et al, 1999;Spiewankiewicz et al, 2003;Stamatellos et al, 2008) may significantly improve the pregnancy rates. Recently, we reported the outcome of nine women with endometrial polyps less than 1.5 cm after hysteroscopic polypectomy (Madani et al, 2009b). Polypectomy was performed during ovarian stimulation (in eight patients with the standard long protocol) or during hormone replacement therapy (in one donor egg recipient).…”

“…During this process, there is a massive secretion of different cytokines and www.intechopen.com Increasing Pregnancy by Improving Embryo Transfer Techniques 137 growth factors, known to play important roles in implantation (Basak et al, 2002). Although several studies have reported good outcomes following hysteroscopic polypectomy during ovarian stimulation in IVF cycles (Batioglu & Kaymak, 2005;Madani et al, 2009b), due to debates over this topic, it is advisable to evaluate the uterine cavity prior to stimulation in order to determine the presence of an existing endometrial pathology.…”