Do Uterine Polyps Need To Be Removed Before In-Vitro Fertilization?
In-vitro fertilization success rates have slowly and steadily improved over the past 30 years. This improvement has been the result of continuous re-evaluation and revision of all components of the preparation for treatment as well as the treatment process itself. Through the years we have developed numerous excellent ovulation stimulation protocols, consistent success with the egg removal procedure, vast improvements in laboratory culturing techniques, and significant refinements in the embryo transfer procedure. In spite of these advances, improving implantation rates remains somewhat elusive. Most patients will successfully complete the stimulation phase of treatment, egg retrieval, fertilization, and will have embryos transferred to the uterus. Depending mostly on the woman’s age, live birth will be achieved in approximately 20-50% of women who have embryos transferred. In an effort to improve implantation rates, physicians have often recommended removal of uterine polyps when they are discovered during the workup leading to IVF. The prevailing wisdom has been that these polyps decreased implantation rates and should therefore be removed prior to treatment.
A Turkish study, presently in-press, sheds some light on this issue. This study looked at 128 patients who were diagnosed with a uterine polyp less than 1.5cm in size during an ICSI (intra-cytoplasmic sperm injection) treatment cycle. These patients did not have their polyps removed and were compared to 128 matched control patients without a uterine polyp. The clinical pregnancy rates and live birth rates were not different between the two groups suggesting that endometrial polyps less than 1.5cm in diameter do not require surgical intervention.
This is an important study which improves our understanding of small uterine polyps and their impact on embryo implantation. It allows clinicians to bypass surgical removal of these polyps, avoiding the risks of surgery and unnecessary delays in treatment.