Hysteroscopic polypectomy for women undergoing IVF treatment: when is it necessary?

The objectives of the present review are to discuss the role of endometrial polyps in infertility and to analyze the evidence for hysteroscopic polypectomy prior to IVF.

Endometrial polyps are frequently found during routine workup for infertility and are known to negatively impact endometrial receptivity through various mechanisms. Overall, most studies to date point to a favorable effect of hysteroscopic polypectomy on subsequent fertility. A recent meta-analysis showed a four-fold increase in expected pregnancy rates following hysteroscopic polypectomy in women planning to undergo intrauterine insemination, and although there are no randomized controlled trials specifically addressing hysteroscopic polypectomy prior to IVF, several large studies suggest a beneficial effect of hysteroscopy both prior to initial IVF and after failed IVF as intrauterine abnormalities, mostly endometrial polyps, are found in a significant proportion of the infertile population. There may be an added benefit of hysteroscopy itself in facilitating subsequent embryo transfer via dilation of the cervix or by increasing endometrial receptivity through endometrial injury.

Hysteroscopic polypectomy is a minimally invasive procedure with little risk of complication and therefore should be performed prior to IVF to optimize chances for successful implantation.