In a reproductive‑age woman undergoing in vitro fertilization (IVF), how soon after hysteroscopic removal of a uterine polyp can embryo transfer be performed?

Timing of Embryo Transfer After Hysteroscopic Polypectomy

Embryo transfer can be performed after the next menstrual cycle following hysteroscopic polypectomy, with optimal outcomes achieved when transfer occurs within 120 days of the procedure.

Evidence-Based Timing Recommendations

Immediate Next Cycle Transfer is Safe and Effective

• Fresh embryo transfer can begin after the first menstrual cycle following polypectomy without compromising outcomes 1
• A large retrospective study of 487 patients found no differences in implantation rates (42.4%), clinical pregnancy rates (48.5%), or live birth rates (44.0%) when IVF was started after the next menses compared to waiting 2-3 cycles or more than 3 cycles 1
• Ovarian stimulation parameters including total stimulation days, gonadotropin doses, and oocyte retrieval numbers were equivalent regardless of waiting time 1

Critical 120-Day Window for Frozen Embryo Transfer

• For frozen-thawed blastocyst transfer specifically, performing the transfer within 120 days of polypectomy yields superior pregnancy rates 2
• Transfers performed within 120 days showed significantly higher biochemical pregnancy rates (73.2% vs 45.2%, OR 3.3) and clinical pregnancy rates (64.8% vs 41.9%, OR 2.54) compared to intervals exceeding 120 days 2
• While implantation and live birth rates did not reach statistical significance, the trend favored earlier transfer 2
• Patients should not wait longer than 120 days between polypectomy and frozen embryo transfer to optimize pregnancy outcomes 2

Clinical Algorithm for Decision-Making

For Fresh IVF Cycles:

• Perform hysteroscopic polypectomy 1
• Wait for one menstrual cycle to confirm normal menstrual pattern 3
• Begin ovarian stimulation immediately after the next menses 1
• Proceed with fresh embryo transfer in the same cycle 1

For Frozen Embryo Transfer Cycles:

• Perform hysteroscopic polypectomy 2
• Schedule frozen embryo transfer within 120 days of the procedure 2
• Confirm endometrial thickness ≥7-8mm with trilaminar pattern before progesterone initiation 4
• Calculate transfer timing precisely from first progesterone dose (117-120 hours for blastocyst) 4

Supporting Evidence for Polypectomy Benefits

• Hysteroscopic polypectomy normalizes menstrual patterns in 91.6% of patients 3
• Spontaneous pregnancy rates reach 61.4% and delivery rates 54.2% after polypectomy in previously infertile women 3
• Pregnancy outcomes after frozen embryo transfer in patients with prior polypectomy are comparable to those without polyps when appropriate timing is followed 2
• The procedure has a low complication rate of 2.4% and recurrence rate of 4.9% 3

Important Caveats

• Avoid blind dilatation and curettage for polyp removal, as hysteroscopy is the standard approach with superior outcomes 5
• The size or number of polyps does not affect fertility rates after polypectomy, so all polyps should be removed regardless of dimensions 3
• Type of infertility (primary vs secondary) does not influence post-polypectomy pregnancy rates 3
• While one small case series reported same-cycle transfer after polypectomy performed just before oocyte retrieval, this approach requires more evidence before routine adoption 6