Management of endometrial polyps in subfertile women: a systematic review

The aim of this systematic review is to evaluate the evidence for the impact of polypectomy on fecundity, implantation and live birth rates in women who are trying to conceive spontaneously or by assisted conception. A literature search was performed to identify all controlled studies that compared the effects of polypectomy or conservative management of the polyp on pregnancy outcome. Among the three studies that met the inclusion criteria, only one was a randomized controlled trial, which reported a significantly higher pregnancy rates after polypectomy in women undergoing intrauterine insemination. The other two studies were retrospective and suggested no beneficial effects of polypectomy on women undergoing assisted conception. Meta-analytic pool was not feasible as the studies varied in their design and the characteristics. While there is some evidence from basic science studies to suggest a detrimental effect of polyps on fertility, the evidence from clinical studies is scarce and conflicting. Polyps diagnosed prior to commencement of controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF) should therefore be removed. The management of polyps seen during the course of COH for IVF should be individualized given the number of embryos created, the previous reproductive history of the patient and the individual clinics' success rates for their frozen embryo programme.