Uterine polyps are common gynecological findings characterized by abnormal tissue growth within the womb. These growths, often found incidentally during fertility investigations, represent an overgrowth of the inner lining of the uterus, known as the endometrium. The presence of uterine polyps can significantly interfere with a woman’s reproductive health, impacting both the ability to conceive and the maintenance of a pregnancy.
What Are Uterine Polyps?
Uterine polyps, also called endometrial polyps, are non-cancerous growths that form from an overgrowth of the endometrial tissue lining the inside of the uterus. They attach to the uterine wall by either a broad base or a thin stalk and can vary in size. While polyps are most common in women nearing or past menopause, they are also frequently found in women of reproductive age.
The development of these growths is strongly linked to hormonal factors, as polyps are considered estrogen-sensitive. Estrogen causes the endometrial lining to thicken each month, and excessive stimulation of this process contributes to polyp formation. Many polyps do not cause noticeable symptoms, but some women experience irregular menstrual bleeding, spotting between periods, or a heavy menstrual flow.
Endometrial polyps are the primary concern for conception. They are estimated to be present in up to 24% of women experiencing abnormal bleeding and up to 10% of the general population.
How Polyps Impede Conception and Pregnancy
Uterine polyps negatively affect fertility through physical and biochemical mechanisms. The most direct interference is physical disruption of embryo implantation. The polyp acts as a space-occupying lesion within the uterine cavity, making it difficult for a developing embryo to attach properly to the uterine wall.
A polyp can also create a localized inflammatory environment within the endometrium. This chronic inflammation alters the biochemical signaling of the uterine lining, making the uterus less receptive to pregnancy. Furthermore, polyps may produce certain substances that inhibit immune tolerance, rendering uterine lining hostile to implantation.
Polyps can also impede conception by interfering with sperm transport. Large polyps, especially those situated near the cervix or the openings of the fallopian tubes, may physically obstruct the pathway sperm must travel to reach the egg.
Diagnosing and Removing Uterine Polyps
Identifying uterine polyps often begins with imaging techniques, as many women are asymptomatic or present with abnormal bleeding or infertility. Transvaginal ultrasound is a common initial step. A more detailed view is achieved using saline-infusion sonography (SIS). During an SIS, sterile fluid is introduced into the uterus to distend the cavity, allowing the ultrasound to clearly visualize the polyp outline.
The definitive diagnostic and treatment procedure is a hysteroscopic polypectomy. Hysteroscopy involves inserting a thin, lighted telescope called a hysteroscope through the vagina and cervix into the uterine cavity. This allows the clinician to directly visualize the polyp, which is considered the gold standard for both diagnosis and treatment.
The polyp is precisely removed using small surgical tools passed through the hysteroscope, ensuring that the surrounding healthy endometrial tissue is preserved. This minimally invasive surgery is typically performed as an outpatient procedure, often under local or general anesthesia. The removed tissue is always sent for analysis to confirm it is benign and rule out any precancerous or cancerous changes.
Patients typically experience a short recovery period, returning home the same day and resuming normal activities within a couple of days. Common side effects include mild cramping, similar to menstrual pain, and light spotting for a few days. Patients are usually advised to avoid strenuous activity and refrain from inserting anything into the vagina for up to two weeks.
Fertility Outcomes Following Polyp Removal
The removal of uterine polyps through hysteroscopic polypectomy significantly improves fertility outcomes for women previously unable to conceive. For women with unexplained infertility, studies indicate that removing the polyp can raise the spontaneous pregnancy rate from a range of 14% to 42% up to 63% to 78%. This improvement suggests the polyp was the primary factor hindering conception.
The positive impact extends to those undergoing assisted reproductive technologies, such as intrauterine insemination (IUI) and in vitro fertilization (IVF). Women undergoing IUI saw a higher cumulative pregnancy rate after polyp removal compared to those who did not have the procedure. Similarly, for IVF, the success rate of embryo transfer is generally higher after polypectomy, demonstrating the restored receptivity of the uterine lining.
The prognosis for future pregnancy does not appear statistically different based on the size or the number of polyps removed. Following the procedure, the menstrual pattern is normalized for the majority of patients, which is another indicator of a healthier uterine environment. While recurrence of polyps is possible, the initial removal provides a strong chance for successful conception.