What is Endometrial Polyp?
💡 Endometrial polyp = soft tissue overgrowth inside the uterine cavity. Common: found in 10–32% of infertile women. Symptoms: abnormal uterine bleeding, spotting, or asymptomatic. Diagnosed by TVS, SIS, or hysteroscopy. Fertility impact: reduces implantation rate. Treatment: hysteroscopic polypectomy (day procedure). Should be removed before IUI or IVF.
An endometrial polyp is a localised overgrowth of endometrial glands and stroma forming a pedunculated or sessile protrusion into the uterine cavity. Endometrial polyps are found in 10–32% of infertile women and are associated with reduced IVF implantation rates and increased miscarriage risk. Hysteroscopic polypectomy before IVF or IUI significantly improves outcomes and is a straightforward day procedure.
🇮🇳 India Context: Endometrial Polyp is widely assessed and treated across major Indian fertility centres including Chennai, Mumbai, Bangalore, Delhi, and Hyderabad.
What are the key characteristics of Endometrial Polyp?
- Prevalence in infertility: found in 15–32% of infertile women on hysteroscopy or SIS; often asymptomatic — discovered incidentally on TVS or during fertility workup
- Fertility mechanisms: impaired endometrial receptivity (polyp acts as an intrauterine device-like foreign body); distortion of cavity surface (embryo cannot implant on polyp epithelium); altered endometrial gene expression; possible mechanical interference with sperm transport
- IVF impact: polyps ≥1cm significantly reduce IVF implantation rates; even smaller polyps may impair outcomes; polypectomy before IVF (ESTEEM RCT) showed significant improvement in ongoing pregnancy rates
- Diagnosis: TVS (sensitivity ~70% for polyps; may appear as echogenic area in cavity); SIS (saline sonography — sensitivity >90%; polyp clearly outlined by fluid); diagnostic hysteroscopy — gold standard (direct visualisation and characterisation)
- Hysteroscopic polypectomy: office or day-procedure hysteroscopy; polyp base grasped with forceps and avulsed or resected with hysteroscopic scissors/loop; no general anaesthesia required for small polyps (<1cm)
- Tissue analysis: all resected polyp tissue sent for histopathology — rare cases reveal endometrial hyperplasia or early malignancy (especially postmenopausal or high-risk patients)
- Timing before IVF: polypectomy should be completed ≥4–6 weeks before embryo transfer to allow endometrial healing; most clinics repeat SIS or diagnostic hysteroscopy before transfer to confirm clear cavity
- Recurrence: polyps recur in ~30% at 3 years; if recurrent polyps (especially with progestogen use in FET cycles), consider alternative endometrial preparation
How does Endometrial Polyp work?
Why does Endometrial Polyp matter in fertility?
Hysteroscopic polypectomy is one of the simplest and highest-value fertility interventions — a 15-minute outpatient procedure that significantly improves IVF and IUI outcomes. The ESTEEM multicentre RCT (2022) demonstrated a 9% absolute improvement in ongoing pregnancy rates after polypectomy before IUI. All fertility patients should have systematic cavity assessment (SIS or hysteroscopy) before starting treatment — a missed polyp is one of the most common and most preventable causes of repeated IVF implantation failure.
What are related terms to Endometrial Polyp?
Polypectomy
Polypectomy is the surgical removal of a uterine polyp. In fertility medicine, i…
Hysteroscopy
Hysteroscopy is a procedure used to examine the inside of the uterus. A thin, li…
Saline Sonogram (SIS)
A saline sonogram (saline infusion sonography, SIS) is a minimally invasive ultr…
Embryo Transfer
Embryo Transfer is the final step of the IVF process. A laboratory-cultured embr…
Recurrent Miscarriage
Recurrent Miscarriage means two or more pregnancy losses before 20 weeks. It aff…
FAQs about Endometrial Polyp
What is an endometrial polyp?
An endometrial polyp is a soft, benign growth arising from the lining of the uterine cavity (endometrium). It forms when a localised area of endometrial glands and stroma overgrows and protrudes into the cavity. Polyps range from a few millimetres to several centimetres. They are found in 10–32% of infertile women — many have no symptoms and are discovered incidentally during a fertility scan. The main fertility concern is that polyps reduce implantation rates and IVF success.
Do endometrial polyps affect IVF success?
Yes — endometrial polyps reduce IVF implantation rates. Polyps ≥1cm are particularly associated with lower ongoing pregnancy rates. The ESTEEM multicentre RCT (2022) showed that removing endometrial polyps before IUI increased ongoing pregnancy rates by 9 percentage points (absolute improvement). For IVF, polyps are believed to impair implantation by acting as an intrauterine foreign body, altering endometrial blood flow, and changing the local hormonal environment. Hysteroscopic removal before IVF is strongly recommended.
How are endometrial polyps diagnosed?
Three methods: (1) Transvaginal ultrasound (TVS): detects ~70% of polyps as an echogenic (bright) area or thickening within the cavity — best performed in the proliferative phase (Days 5–12) when the endometrium is thin; (2) Saline infusion sonography (SIS/sonohysterography): saline injected into the cavity outlines polyps with >90% sensitivity — best outpatient test; (3) Hysteroscopy: gold standard — direct visualisation of the cavity with camera; allows simultaneous removal ("see and treat") under local anaesthetic or sedation.
How are endometrial polyps removed?
Endometrial polyps are removed by hysteroscopic polypectomy — a minimally invasive procedure: the hysteroscope (camera) is passed through the cervix; the polyp is visualised and removed using grasping forceps (small polyps — avulsed by twisting) or resected with hysteroscopic scissors or a bipolar loop (larger polyps). The procedure takes 15–20 minutes in an office or day-case setting; local anaesthetic or light sedation is used. All removed tissue is sent for histopathology. IVF or IUI can proceed from the next menstrual cycle after removal.
Can endometrial polyps come back after removal?
Yes — endometrial polyps recur in approximately 15–30% of women at 3 years after hysteroscopic removal. Recurrence is more common in women using progestogen-only HRT (paradoxically), those with PCOS (oestrogen excess), and older women. If polyps recur repeatedly before IVF FET cycles (where progestogen is given for endometrial preparation), an alternative FET protocol (e.g., natural cycle FET) may be considered to reduce progestogen-driven polyp formation. Serial TVS or SIS before each embryo transfer is recommended in women with a history of polyps.
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