Uterine polyps are common growths arising from the endometrium, the inner lining of the uterus. They are soft and attach to the uterine wall by a thin stalk or broad base, extending into the uterine cavity. Sizes vary from a sesame seed to several centimeters. They are usually benign, though rarely precancerous or cancerous.
Understanding Uterine Polyps
Uterine polyps, or endometrial polyps, are an overgrowth of endometrial tissue. They can occur at any age but are most common in women aged 40-59, peaking between 40 and 49. Many women experience no symptoms, but polyps can lead to noticeable signs. Abnormal uterine bleeding is the most frequent symptom, manifesting as irregular or heavy periods, intermenstrual bleeding, or post-menopausal bleeding. Less common symptoms include mild abdominal or pelvic discomfort, though pain is not typical. The exact cause is not fully understood, but hormonal factors, particularly estrogen, are believed to play a role due to estrogen’s stimulation of endometrial lining growth.
How Uterine Polyps Can Impact Fertility
Uterine polyps can interfere with conception through several mechanisms. They can physically obstruct the uterine cavity, hindering sperm passage and making fertilization difficult. Large or multiple polyps may also block fallopian tube openings, impeding sperm transport or fertilized egg movement into the uterus.
Polyps can also disrupt uterine lining receptivity, crucial for successful embryo implantation. They can create a chronic inflammatory environment within the uterus, making it less hospitable for embryo attachment. Some research suggests polyps may alter endometrial molecular expression, affecting genes important for implantation. Additionally, polyps may interfere with blood flow to the endometrial lining, vital for embryo nourishment and development.
The impact varies by size, location, and number. Not all polyps cause infertility, but those in the cornual portion of the uterus (near fallopian tubes), or larger/more numerous ones, are more likely to cause conception difficulty. Studies indicate polyps can reduce implantation rates and increase miscarriage risk.
Diagnosing Uterine Polyps
Diagnosis typically involves imaging techniques to visualize the uterus. Transvaginal ultrasound is a common initial method, using a slender device to create uterine images. While useful, it may not always provide a definitive diagnosis.
For a clearer view, saline infusion sonography (SIS), or hysterosonography, is often performed. During SIS, sterile saline fluid is introduced into the uterus to expand the cavity and outline growths, making polyps more visible on ultrasound. This technique significantly improves diagnostic accuracy.
Hysteroscopy is the most accurate diagnostic method. It involves inserting a thin, lighted hysteroscope through the vagina and cervix into the uterus, allowing direct visualization of the uterine lining. Hysteroscopy confirms polyps and allows assessment of their size, number, and exact location. A biopsy may be taken during hysteroscopy for laboratory examination to rule out abnormal cells.
Treatment and Fertility Outcomes
Surgical removal is the primary treatment for symptomatic polyps or those affecting fertility. Hysteroscopic polypectomy is the gold standard, allowing direct visualization and precise removal. During this outpatient procedure, a hysteroscope guides surgical instruments to excise polyps from the uterine wall. Removed tissue is sent for analysis to confirm its benign nature.
This “see and treat” approach allows for diagnosis and immediate removal during the same procedure, which is generally well-tolerated and minimally invasive. Patients may experience mild cramping and spotting for a few days. For small, asymptomatic polyps, especially in women not trying to conceive, a “wait and see” approach may be recommended, as some resolve on their own. Hormonal medications may manage symptoms by balancing hormone levels, but symptoms often return after stopping medication.
Removing uterine polyps can significantly improve fertility outcomes for women struggling to conceive. Studies show an increased chance of pregnancy after polypectomy. Polyp removal is particularly beneficial for those undergoing fertility treatments like intrauterine insemination (IUI) or in vitro fertilization (IVF), as it enhances uterine lining receptivity and reduces implantation failure.