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Endometrial Polyps

An endometrial polyp is the overgrowth of the endometrium inside the uterine cavity. It may be attached to the endometrial cavity with a small pedicle or have a broad base. It typically appears as soft tissue that is pliable and may be single or multiple. It is estimated that the prevalence of endometrial polyps in reproductive-aged women is 20-25%. In 1% of the cases, polyps may have cancerous or precancerous cells. Therefore, once diagnosed, it is recommended that all polyps are removed in their entirety and sent to pathology for evaluation.

Polyps are estrogen sensitive and can develop at any time during the reproductive years. They are typically asymptomatic, but in some cases they may cause irregular bleeding. It is believed that endometrial polyps may have an adverse effect on fertility and fertility treatment outcome. Polyps may create an inflammatory reaction inside the uterine cavity or cause irregular bleeding at the time of implantation. These effects would create a hostile environment for the implanting embryo and possibly prevent pregnancy or potentially cause miscarriages. It is still not well understood whether polyps cause infertility or recurrent pregnancy loss.

It appears that removal of endometrial polyps can improve fertility outcome by spontaneous conception, intrauterine insemination (IUI) and by in vitro fertilization (IVF). The best method to remove polyps is hysteroscopy because the entire endometrial cavity can be surveyed and all polyps removed completely. When pregnancy rates are compared before and after removal of endometrial polyps, higher pregnancy rates have been observed following hysteroscopic removal.

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