Managing suspected endometrial polyps during IVF/ICSI stimulation: retrospective cohort study of fresh versus...

In patients in whom endometrial polyps are diagnosed during ovarian stimulation for IVF, are there differences in reproductive outcomes in women continuing to undergo fresh embryo transfer, and those in whom embryos are cryopreserved and hysteroscopic polypectomy carried out after subsequent frozen embryo transfer?

This single centre retrospective cohort analysis in a tertiary fertility centre included patients aged between 18 and 42 years with a newly diagnosed endometrial polyp during ovarian stimulation for IVF/ICSI between May 2008 and July 2021. A total of 372 patients were divided into two groups based on strategy: fresh embryo transfer (n = 256) and cryopreservation of embryos followed by hysteroscopy and subsequent frozen embryo transfer, referred to as the 'freeze-all' group (n = 116).

A minimal difference in polyp size (maximum diameter measured on ultrasound) was observed in the fresh embryo transfer (10.1 ± 4.3 mm) versus freeze-all group (11.2 ± 4.4 mm) (P < 0.001), with no significant difference in the various polyp locations. The freeze-all group had a higher oocyte yield (8.1 ± 5.0 versus 12.5 ± 8.3, P < 0.001) with a significantly higher proportion of blastocysts transferred in this group (35.2% versus 68.1%, P < 0.001). No significant difference was observed in clinical pregnancy (94/256 versus 47/116) or live birth rates (68/256 versus 33/116), only for early pregnancy rate (18/256 versus 16/116, P = 0.036). After adjustment for relevant confounding factors, body mass index, age, number of oocytes retrieved, day of embryo transfer and polyp size, no association was observed between the freeze-all or fresh embryo transfer strategy and live birth rate.

No difference was found in reproductive outcome between a fresh embryo transfer compared with a freeze all strategy and hysteroscopy before frozen embryo transfer.