Endometrial Polyp Management and IVF

Overview of endometrial polyps

Outer growths in the uterine mucosa consisting of blood vessels, endometrial glands and stroma are medically termed as endometrial polyps. Worldwide almost 10 percent of females have diagnosed with endometrial polyps.

However, it has expected that the overall incidence rate is much higher (20 to 30 percent), but due to its asymptomatic nature is often undiagnosed. The condition is often identified due to extreme uterine bleeding or infertility.   

It is not necessary all females with endometrial polyps are infertile. Many women with endometrial polyps have successfully pregnant. But clinical researchers have found a link between endometrial polyps and sub-fertility issues. The presence of polyps often interferes with pregnancy or repeated miscarriage. Polyps cause negative endometrial receptivity, which leads to implantation failure.

Prevalence and impact of endometrial polyps on IVF

Almost 11 to 45 percent of the female have diagnosed with endometrial polyps by hysteroscopy conducted before in-vitro-fertilization (IVF). Research findings also suggested that more than 16% of repeated failure of IVF has occurred due to the presence of endometrial polyps.

Evidential management of endometrial polyps on IVF cycle

Management of endometrial polyps starts before ovarian stimulation is essential for IVF. The possible treatment plan for endometrial polyps detection during the IVF treatment includes ovarian stimulation continued followed by fresh transfer, cryopreservation of all the created embryos or after removal of the polyps the frozen-thawed embryos are replaced. In some cases, cancellation of the IVF cycle until the polyp removal has completed.

The choice of the treatment plan is based on several factors, like the number of embryos created, previous reproductive history and the success rate of the frozen embryo transfer. Above all, the clinician’s preference depending upon the individual patient’s condition.

  • A human research trial finding reported that 83 women with less than 2cm polyp sized had divided into two groups. Fresh embryo transfer without poly removal was conducted in the first group, whereas in the second group, the created embryo was cryopreserved and transferred the frozen-thawed embryos after removal of the polyps. In both groups, the rate of pregnancy and the duration of the treatment are almost the same. But fresh transfers tend to increase pregnancy loss than another group.
  • Another trial result showed that the size of the endometrial polyp less than 1.5cm did not create a significant difference in pregnancy and implantation rates on intracytoplasmic sperm injection (ICSI) cycles.
  • A small scale research study also reported that hysteroscopic polypectomy on IVF outcome without cycle cancellation might not be provided a detrimental effect on the IVF cycle outcome.

Overall the study findings have supported that the size of the endometrial polyps is very important for both IVF and ICSI treatment planning. The live birth rate may not differ if the patient underwent hysteroscopic polypectomy before stimulation. This result was obtained by comparing control group patients without endometrial polyps who underwent a standard ICSI cycle.

Read Also: Trying to Conceive with Endometriosis and fibroids after 40

Recent Treatment Preference

In current medical practice, the doctors do not prefer to conduct polypectomy during stimulation to avoid harm just before embryo transfer. In a recent trend, clinicians prefer to perform routine 3D SIS test before IVF cycles in both fresh or frozen embryo transfers. This test helps to detect polyps before stimulation. Doctors prefer to conduct hysteroscopic polypectomy before stimulation in case of a positive finding.

It has also reported frozen embryo transfer cycle outcome is better than a fresh transfer. Therefore, clinicians prefer to freeze all embryos after egg collection and plan for a hysteroscopic polypectomy followed by a frozen embryo transfer cycle in case of positive endometrial polyps findings.

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