No evidence to support the concept that endometrial polyps impair fertility in the majority of cases

Abstract

Purpose: To perform an updated literature search to determine whether hysteroscopic polypectomy helps to improve chance of pregnancy in infertile couples or reduce the risk of miscarriage. Materials and Methods: The authors conducted a personal review of the literature since 2009 (the last time such a search on the subject of polypectomy for infertility and miscarriage was performed by one of the authors). Results: No new studies were identified except a recent (2014) Cochrane Collaboration review from Polanski et al. was found. These authors had the same objective as we had in our previous publication in which an alleged randomized prospective trial (RCT) suggested that hysteroscopic polypectomy improved pregnancy rates following intrauterine insemination (IUI) vs. controls; however they included pregnancies obtained within three months after the procedure but before the four-month study period of IUI. Other flaws of the Perez-Medina study of 2005, that are even more significant, were pointed out by Polanski et al. Conclusions: Though no new studies shedding more insight whether the presence of endometrial polyps can impair fertility potential have been found, more flaws in design and conclusions of the one alleged RCT trail by Perez-Medina have been determined by a Cochrane review leading to the conclusion that there is not one properly designed and conducted RCT that supports hysteroscopic polypectomy to correct infertility in asymptomatic women. Though the possibility exists that irritating the endometrium by polypectomy can promote an inflammatory type endometrium, and thus improve embryo implantation and trophoblast invasion, other less invasive, less risky, less costly procedures can be performed, e.g., a single one swipe endometrial biopsy (now referred to as an endometrial scratch).