From the Guidelines
Yes, an endometrial polyp can cause infertility in some cases, as it can interfere with embryo implantation, alter the uterine environment, and affect blood flow to the endometrium, making it less receptive to a fertilized egg. Endometrial polyps are abnormal tissue growths that can develop in the uterine cavity and have been identified as a potential cause of infertility in women [1]. The use of contrast sonohysterography or saline infusion sonohysterography (SIS) has been shown to be effective in detecting intrauterine abnormalities, including endometrial polyps, with a sensitivity of 75% and specificity of 93% [1].
When evaluating infertility, it is essential to assess the uterine cavity for potential causes, including endometrial polyps, leiomyomas, and intrauterine adhesions [1]. The diagnosis of endometrial polyps can be made using transvaginal ultrasound or hysteroscopy, with hysteroscopy being the gold standard for diagnosis [1]. Treatment of endometrial polyps typically involves surgical removal through hysteroscopic polypectomy, which can improve fertility outcomes in women with polyp-related infertility [1].
Key points to consider when evaluating the relationship between endometrial polyps and infertility include:
- The use of SIS or contrast sonohysterography for detecting intrauterine abnormalities, including endometrial polyps
- The importance of assessing the uterine cavity for potential causes of infertility
- The role of hysteroscopy in diagnosing and treating endometrial polyps
- The potential for improved fertility outcomes after removal of endometrial polyps.
From the Research
Endometrial Polyps and Infertility
- Endometrial polyps are frequently seen in subfertile women, and there is some evidence suggesting a detrimental effect on fertility 2.
- The presence of an endometrial polyp may contribute to subfertility through mechanical interference with sperm transport, embryo implantation, or through intrauterine inflammation or altered production of endometrial receptivity factors 2.
- Studies have shown that hysteroscopic polypectomy can improve fertility in women with otherwise unexplained infertility 3, 4.
Effect of Polypectomy on Pregnancy Rates
- A study found a statistically significant difference in cumulative pregnancy rates between women who underwent polyp removal and those who did not, with the group that underwent polyp removal having higher pregnancy rates 3.
- A meta-analysis showed a four-fold increase in expected pregnancy rates following hysteroscopic polypectomy in women planning to undergo intrauterine insemination 4.
- However, there is no strong evidence to support polypectomy as a way to improve the pregnancy rate in infertile women who plan to undergo IVF or polypectomy during controlled ovarian stimulation for IVF 5.
Management of Endometrial Polyps
- Considerable disagreement exists regarding whether endometrial polyps should be removed before attempting natural pregnancy and before pregnancy via intrauterine insemination (IUI) or in vitro fertilization (IVF) 5.
- Endometrial polypectomy is currently justified in patients with repeated IVF failure, but more studies are needed to verify that endometrial polypectomy itself will eventually increase the pregnancy rate 5.
- The management of endometrial polyps should be individualized depending on the patient's situation and clinician's preference 5.