Polyps and Infertility
Removing Polyps May Improve Fertility
Removing polyps increases pregnancy rate by 110% over biopsy alone
A total of 215 infertile women with ultrasonographically diagnosed endometrial polyps (EP) undergoing IUI were randomly allocated to one of two pretreatment groups. Hysteroscopic polypectomy was performed in the study group. Diagnostic hysteroscopy and polyp biopsy was performed in the control group. RESULTS: Total pregnancy rates and time for success in both groups after four IUI cycles were compared. Women in the study group had a better possibility of becoming pregnant after polypectomy, with a relative risk of 2.1. Pregnancies in the study group were obtained before the first IUI in 65% of cases. CONCLUSIONS: These data suggest that hysteroscopic polypectomy before IUI is an effective measure.
http://humrep.oxfordjournals.org/content/20/6/1632.long
Removing polyps improves pregnancy rates over those who decline treatment
To evaluate the effect of the presence of endometrial polyps on pregnancy rates and how polypectomy could affect pregnancy rates in women scheduled for intrauterine insemination (IUI). METHODS: The study included patients who were candidates for IUI. The study group consisted of 86 women who, following the diagnosis of endometrial polyp, had agreed to have the polyps removed hysteroscopically prior to the IUI. The control group consisted of 85 women, who despite the fact that the presence of an endometrial polyp had been previously diagnosed and its removal suggested, elected not to have the polyp removed. We used statistical analysis to check what effect the removal of the polyp had on the total number of pregnancies. RESULTS: There was a statistically significant difference in cumulative pregnancy rates between the two groups. The group that underwent polyp removal had higher pregnancy rates as compared to the one that the polyps were left intact. CONCLUSIONS: We propose that hysteroscopic polypectomy of any size appears to improve fertility in women with otherwise unexplained infertility.
http://www.ncbi.nlm.nih.gov/pubmed/23157028
Polyps <2cm do not decrease pregnancy rate, but may increase miscarriage
Endometrial polyps less than 2 cm in diameter were suspected by transvaginal ultrasound before oocyte recovery in 83 patients. Forty-nine women (Group I) had standard IVF-embryo transfer, while in 34 women (Group II) hysteroscopy and polypectomy were performed immediately following oocyte retrieval, the suitable embryos were all frozen, and the replacement cycle took place a few months later. RESULTS: Of the 32 hysteroscopies, a polyp was diagnosed in 24 cases (75%) and polypoid endometrium in another 5 patients (15.6%). An endometrial polyp was confirmed by histopathological examination in 14 women (58.3%). The pregnancy rate in group I was similar to the general pregnancy rate of our unit over the same period (22.4 vs 23.4%) but the miscarriage rate was higher (27.3 vs 10.7%, P = 0.08). In Group II, the pregnancy and miscarriage rates were similar to those of the frozen embryo cycles at Bourn Hall (30.4 and 14.3 vs 22.3 and 12.1%, respectively). CONCLUSIONS: Small endometrial polyps, less than 2 cm, do not decrease the pregnancy rate, but there is a trend toward increased pregnancy loss. A policy of oocyte retrieval, polypectomy, freezing the embryos, and replacing them in the future might increase the "take-home baby" rate.
http://www.ncbi.nlm.nih.gov/pubmed/10478319
Removing polyps increases birth rate vs infertile controls
Of the 78 women with diagnoses of infertility, 36 had myomectomies, 23 had polypectomies, and 19 had normal cavities. Among the three groups, there were no significant differences in age, type of infertility, length of infertility, or follow-up after the procedure. Polypectomy subjects had significantly higher pregnancy and live birth rates than women with normal cavities. Women who had myomectomies larger than 2 cm had significantly higher pregnancy and live birth rates, achieving statistical significance at a myoma size of 3 cm or greater for live births. Spontaneous abortion rates among first pregnancies after myomectomy, polypectomy, or normal study were similar: 31.5%, 27.7%, and 37.5%, respectively. CONCLUSION: Both hysteroscopic polypectomy and hysteroscopic myomectomy appeared to enhance fertility compared with infertile women with normal cavities. Despite concern that hysteroscopic resection of a large myoma might ablate a large surface area of the endometrial cavity, the reproductive benefit appears greater than the risk.
http://www.ncbi.nlm.nih.gov/pubmed/10432121
Polyps more common in infertile women; 50% pregnancy rate after removal
In a prospective study, 266 consecutive infertile women had undergone complete fertility evaluation. None of the women had experienced any change in their menstrual cycle. They were divided into two groups; 235 infertile patients (group 1) and 31 requesting a reversal of a previous tubal sterilization (group 2). All patients were examined by simultaneous combined laparoscopy and hysteroscopy as part of their routine infertility evaluation. When endometrial polyps were noted they were removed by hysteroscopy and histopathologically examined. Patients in whom the only apparent finding was endometrial polyps were followed up to determine their reproductive outcomes subsequent to removal of the polyps. RESULTS: Of the 224 uterine cavities successfully visualized in the infertile group, 134 were judged to be normal (60%) and 90 were abnormal (40%). Endometrial polyps were noted in 35 patients of group 1 and in one patient of group 2. Most polyps were located in the region of the utero-tubal junction and proved to be functional. A 50% pregnancy rate was achieved by hysteroscopic polypectomy. Fertility-related factors in women whose only apparent finding was endometrial polyps before and after hysteroscopy were comparable. CONCLUSION: Diagnostic hysteroscopy should be used routinely in the work-up of infertile woman, even in the presence of normal menstrual cycles. Persistent functional endometrial polyps, even if small, are likely to impair fertility in this select patient group. Removal of such lesions may improve subsequent reproductive performance.
http://www.ncbi.nlm.nih.gov/pubmed/15009608
Polyps reduce levels of implantation factors; removal reverses this effect
The aim of this study was to investigate the levels of insulin-like growth factor 1 binding protein (IGFBP-1) and glycodelin levels in uterine flushings before and after hysteroscopic polypectomy. RESULTS: The glycodelin and IGFBP-1 levels are significantly lower in patients with uterine polyps than in patients having menorrhagia preoperatively. In patients with uterine polyps, both glycodelin and IGFBP-1 were significantly increased postoperatively, while no significant changes in their values were noted postoperatively in patients with menorrhagia undergoing endometrial biopsy. CONCLUSIONS: Decreased levels of mid-secretory IGFBP-1 and glycodelin were associated with the presence of endometrial polyps and both were reversed following hysteroscopic polypectomy. This could explain the pathophysiological mechanisms by which endometrial receptivity is impaired in the presence of endometrial polyps.
http://www.ncbi.nlm.nih.gov/pubmed/22239027
Removing Polyps May Not Improve Fertility
No effect of polyps on IVF success; no benefit from removal
PURPOSE: To determine if endometrial polyps negatively effect outcome following in vitro fertilization-embryo transfer (IVF-ET) and whether hysteroscopic resection improves pregnancy and implantation rates and/or decreases miscarriage rates. METHODS: Retrospective study with two matched controlled groups (polyps vs no polyps) based on age and previous number of IVF failures. The polyp group was further stratified by whether polypectomy was performed or not. RESULTS: There was no difference or even trend for lower pregnancy rates or higher miscarriage rates with the presence of endometrial polyps. CONCLUSIONS: These data do not support the recommendation for hysteroscopic resection of endometrial polyps to aid conception rates.
http://www.ncbi.nlm.nih.gov/pubmed/21995145
Location of polyp may effect pregnancy rate after removal
A retrospective study was conducted on infertility patients who had an endometrial polyp, as suspected on the basis of ultrasound and as diagnosed by hysteroscopy. INTERVENTION(S): Polyps were excised by either polypectomy or curettage. The patients received < or =6 months of follow-up; pregnancy rates were compared between the five subdivisions. RESULT(S): The pregnancy rate after surgery was as follows, by location: uterotubal junction, 57.4%; posterior uterine wall, 28.5%; anterior uterine wall, 14.8%; lateral uterine wall, 18.8%; and multiple, 40.3%. The pregnancy rate after surgery at the uterotubal junction was significantly higher than that of other locations. CONCLUSION(S): Endometrial polyps are commonly found on the posterior wall of the uterus; however, excision of polyps that were located at the uterotubal junction significantly improved the pregnancy rate. Endometrial polyps should be categorized by both size and location.