A diagnosis of uterine polyps often raises concerns about fertility. The presence of these growths in the uterus can affect the ability to become pregnant, but they do not automatically prevent it. For many individuals, uterine polyps become a factor in otherwise unexplained difficulty achieving or maintaining a pregnancy. The good news is that these growths are highly treatable, and their removal can significantly improve the chances of conception.
What are Uterine Polyps
Uterine polyps, also known as endometrial polyps, are growths that form in the endometrium, the inner lining of the uterus. They develop from an overgrowth of this tissue, extending inward into the uterine cavity. These growths are typically attached to the uterine wall either by a thin stalk or a broad base, and their size can vary widely.
The vast majority of uterine polyps are benign, meaning they are non-cancerous, though all removed polyps are sent for laboratory analysis to confirm this. The development of polyps is linked to fluctuations in the hormone estrogen, which causes the uterine lining to thicken each month. While many people with polyps experience no symptoms, others may notice abnormal bleeding patterns, including irregular menstrual periods, spotting between periods, or unusually heavy menstrual flow.
How Polyps Interfere with Conception
Uterine polyps interfere with conception through several distinct biological and physical mechanisms. One primary way is by acting as a physical barrier within the uterine cavity. The polyp occupies space, physically obstructing the area where an embryo needs to successfully implant into the uterine wall. This mechanical interference is particularly disruptive when the polyp is located near the fallopian tubes or a likely implantation site.
Beyond a simple physical barrier, polyps can also induce a localized inflammatory response in the endometrium. This creates a less receptive environment that can reduce embryo viability and make implantation more difficult. Polyps may also alter the cellular environment by producing substances that render the uterine lining less receptive to an embryo. Furthermore, polyps located lower in the uterus may interfere with the transport of sperm into the fallopian tubes.
Diagnosis Methods and Medical Consultation
If you have been trying to conceive without success, a medical consultation is warranted, typically after 12 months for those under 35 or six months for those 35 and older. The investigation often begins with imaging to check for potential structural issues like uterine polyps. The first step usually involves a transvaginal ultrasound, which uses sound waves to create images of the uterus and ovaries.
However, a standard ultrasound can sometimes miss polyps or fail to distinguish them clearly from other tissue, so a more specialized test is often used. Saline Infusion Sonohysterography (SIS), also called a hysterosonogram, is a highly effective diagnostic tool. This procedure involves injecting sterile saline solution into the uterine cavity while performing an ultrasound, which distends the uterus and allows for a clearer view of any growths.
The most definitive method for both diagnosis and immediate treatment is hysteroscopy. This procedure involves inserting a thin, lighted camera through the cervix into the uterus, allowing the physician to directly visualize the uterine cavity. Hysteroscopy is considered the optimal method because it provides a direct, high-resolution view and confirms the exact size and location of any polyps. In some cases, a hysterosalpingogram (HSG), an X-ray test using dye to check the fallopian tubes, may also inadvertently reveal the presence of polyps.
Treatment Procedures and Fertility Improvement
The primary treatment for uterine polyps, especially when fertility is a concern, is a procedure called hysteroscopic polypectomy. This is a minimally invasive surgical procedure performed under direct visualization using a hysteroscope. The doctor is able to clearly see the polyp and carefully remove it from the uterine wall while preserving the surrounding healthy endometrial tissue.
Hysteroscopic removal is preferred over older, less precise methods like blind curettage because the direct visualization leads to a more complete removal and helps prevent damage to the uterine lining. Recovery is typically fast, often taking only a few days to a week before resuming normal activities. The removed tissue is always sent to a lab to ensure the growth was benign.
The removal of polyps has been shown to significantly improve pregnancy rates, particularly in individuals with otherwise unexplained infertility. This improvement holds true for both spontaneous conception and for those undergoing assisted reproductive technologies like intrauterine insemination (IUI) or in vitro fertilization (IVF). The improved fertility rates are attributed to restoring the uterine anatomy, reducing inflammation, and enhancing the overall receptivity of the uterine lining for embryo implantation.