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Thoughts on management of infertility

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Polyps and Infertility

Uterine polyps are benign growths of the tissue that lines the uterine cavity.

Sometimes they cause irregular bleeding, but initially they are asymptomatic.

They are commonly discovered in the course of an infertility evaluation.

The most sensitive method for diagnosing them is the saline infusion sonohystogram, an ultrasound evaluation of the uterine cavity in which water in injected into the cavity during the exam. The polyp floats in this water, which provides a contrast to enable the polyp to be seen as separate from the endometrial lining. Very small polyps may be shed with a menstrual period or they may continue to get larger over time.

Most reproductive endocrinologists have felt that polyps may cause a chronic irritation (like an IUD) and at times contribute to infertility or miscarriage. This is well established in the literature for polyps greater than two centimeters in length. However, a recent publication shows that polyps between 1/2 and two centimeters in length also cause subfertility.

Polyps are often diagnosed as part of the preparation for an IVF cycle. One question this raises is whether or not the cycle should be postponed to heal from the polypectomy. Stanford looked at their data and found a higher pregnancy rate when a polyp was removed in the cycle before starting IVF as opposed to a longer interval between IVF and the polypectomy. This is consistent with other studies that suggest that a D&C may enhance implantation for a period of time. Some patients are concerned that a D&C may cause intrauterine adhesions. However, a D&C which causes intrauterine adhesions formation, probably was associated with a pregnancy loss together with a subclinical infection.