Surgical Management of Endometrial Polyps in Infertile Women: A Comprehensive Review

Abstract

Endometrial polyps are benign localized lesions of the endometrium, which are commonly seen in women of reproductive age. Observational studies have suggested a detrimental effect of endometrial polyps on fertility. The natural course of endometrial polyps remains unclear. Expectant management of small and asymptomatic polyps is reasonable in many cases. However, surgical resection of endometrial polyps is recommended in infertile patients prior to treatment in order to increase natural conception or assisted reproductive pregnancy rates. There is mixed evidence regarding the resection of newly diagnosed endometrial polyps during ovarian stimulation to improve the outcomes of fresh in vitro fertilization cycles. Hysteroscopy polypectomy remains the gold standard for surgical treatment. Evidence regarding the cost and efficacy of different methods for hysteroscopic resection of endometrial polyps in the office and outpatient surgical settings has begun to emerge.

Does the time interval between hysteroscopic polypectomy and start of in vitro fertilization affect outcomes?

“…Endometrial polyps are benign lesions of the endometrium that contain glands and stroma (4,5). They may occur as single or multiple lesions, can be sessile or pedunculated, and may range in size from millimeters to centimeters (4,20). Because most endometrial polyps are asymptomatic, their true incidence remains unknown (1,20).…”

“…They may occur as single or multiple lesions, can be sessile or pedunculated, and may range in size from millimeters to centimeters (4,20). Because most endometrial polyps are asymptomatic, their true incidence remains unknown (1,20). Some observational studies have estimated that endometrial polyps can be detected in up to 24% of symptomatic women (21,22).…”

CD4+ T cell imbalance is associated with recurrent endometrial polyps

“…Endometrial polyps (EPs) are localized benign overgrowths at the endometrium . They are usually asymptomatic but can associate with gynaecological conditions such as abnormal uterine bleeding and suboptimal fertility.…”

Macrophages in patients with recurrent endometrial polyps could exacerbate Th17 responses

“…Malignant transformation of EP is rare . In order to treat bleeding and improve fertility, EP can be removed by hysteroscopic polypectomy . However, recurrent EP has been found and depending on the types of EP and the duration of the follow‐up appointments, the recurrence rate can range between 2.5% to 43.6% .…”