Endometrial polyps and fertility

Endometrial polyps and fertility

Benign tumours formed by the mucous membrane covering the inside of the uterus, endometrial polyps are one of the causes of infertility in women, which is why they require immediate treatment.

Endometrial polyps can occur during a woman’s reproductive age and during menopause. The causes of their occurrence are not yet confirmed, but there are studies from which we have concluded that their formation may be due to hormonal factors, septic, or aseptic inflammation. With dimensions varying from a few millimeters to a few centimeters, they usually cause menstrual disorders and mid-cycle bleeding. Stalk-shaped or with a flat base, they form after anarchic overgrowth of endometrial cells that cover the inside of the uterus. In a small percentage, it can be malignant (5.42% in post-menopausal women and 1.7% in women of reproductive age).

Symptoms

  • Irregular cycles, with periods sometimes coming earlier and sometimes later than expected.
  • Increased amount of blood during the period
  • Appearance of droplet haemorrhoids in the middle of the period
  • During menopause, vaginal haemorrhoids occur
  • Intense pain during period
  • Pain during sexual intercourse (dyspareunia)
  • Infertility

Endometrial polyps and infertility

Acting as a natural endometrial spiral, the polyp acts by preventing the fertilized egg from implanting in the endometrial cavity, and when located near the tubal orifices, it prevents sperm from travelling inside the fallopian tube to meet the egg. Also, if it is located at the entrance of the cervix, it prevents the sperm from entering the uterine cavity.

Therefore, as during reproductive age, endometrial polyps can cause problems in implanting the embryo in the uterus, it is advisable to remove them. In fact, according to studies, women who underwent IVF and had a polyp, after its removal, their chances of pregnancy doubled.

The diagnosis

The diagnosis of a polyp is made by An endovaginal ultrasound and confirmation of the polyp’s existence is made by injecting normal serum into the uterine cavity and then by ultrasound imaging (sonohysterography).

How are they treated?

Polyps are always treated surgically and are treated in two ways: a. by curettage of the endometrium and b. by invasive hysteroscopy.

Invasive hysteroscopy is the most popular since it is chosen by more and more gynecologists because it is more precise and detailed, less traumatic and does not cause bleeding. A thin 5 mm diameter device with a camera on top is inserted through the cervix into the endometrial cavity, locates the polyp and, using a small pair of scissors, removes it from the uterine wall. The procedure is usually accompanied by scraping of the endometrium. It is performed vaginally with mild sedation and requires a hospital stay. If the woman is of childbearing age, she can undergo conception procedures two cycles after the polyp is removed. In any case, after hysteroscopic removal, the polyp and what has been scraped from the endometrium is examined histologically to exclude malignancy.

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