Endometrial polyps can affect fertility

What is an endometrial polyp?
An endometrial polyp is a benign growth made of cells from the endometrium (which is the lining of the uterine cavity) and may cause women to experience spotting at a time that is between their monthly periods or may cause no symptoms at all. An endometrial polyp is made of endometrial cells that are more responsive to estrogen levels. Endometrial polyps can be found in up to 25% of women with subfertility.

What are the effects of endometrial polyps on reproduction?
Endometrial polyps have been associated with decreased pregnancy rates and increased miscarriage rates. They are thought to interfere with sperm transport as well as embryo implantation. Basic science studies have demonstrated chronic inflammation in the endometrial tissue that surrounds endometrial polyps. There are studies that have shown improved pregnancy rates and decreased miscarriage rates after endometrial polyps have been removed. “Diagnosis and subsequent treatment of endometrial polyps will optimize the chances for a successful pregnancy”, Dr. Kavoussi explains.

How are endometrial polyps diagnosed?
Endometrial polyps can be diagnosed by means of imaging studies or by endometrial biopsy. Saline infusion sonography (SIS) or hysteroscopy are the more sensitive tests for detecting endometrial polyps. Hysterosalpingography (HSG) is another test that can identify polyps. Standard transvaginal sonography (TVS) without saline infusion is not as reliable for the detection or ruling out of endometrial polyps; however, TVS can show bright spots in the endometrium that may lead to a recommendation for SIS, HSG, or hysteroscopy for further evaluation for, and potential treatment of, endometrial polyps.

How are endometrial polyps removed?
The day surgery during which an endometrial polyp or multiple endometrial polyps are removed is called “hysteroscopic polypectomy”, a procedure called that entails the use of a hysteroscope which is placed transcervically into the uterine cavity for direct, real-time, magnified visualization of endometrial polyps on a video monitor. Next, instruments can be placed through the hysteroscope in order to carefully remove endometrial polyps under continued visualization on the monitor. Once the uterine cavity is cleared of endometrial polyps and normal in appearance, the procedure is complete. It is uncommon for an endometrial polyp to be cancerous in women of reproductive age; however, after endometrial polyps are removed, they are routinely sent to Pathology for analysis. The patient can go home the same day after surgery is complete and she can try for pregnancy a month after hysteroscopic polypectomy.