Hysteroscopic management of subfertility in cases with suspected endometrial polyps

Abstract

Endometrial polyps (EPs) are a common benign gynecologic condition associated with abnormal uterine bleeding (AUB), infertility and recurrent pregnancy loss. Transvaginal ultrasound (TVU) provides an excellent diagnostic technique to identify the size and the anatomic location of endometrial polyps. Its accuracy increases when color Doppler, 3D investigation and saline-infused sonohysterography are used. However, hysteroscopy showed the highest diagnostic accuracy in infertile patients with suspected endometrial polyps and provides a safe and feasible opportunity for EPs removal. Objectives. This study aims to demonstrate the effectiveness of hysteroscopic polyps’ removal in infertile young female patients. Methodology. This study, conducted over a period of one year, included women who addressed our clinic for infertility. These patients were clinically examined and evaluated using transvaginal ultrasound (TVUS). Hysteroscopy was performed on all cases where TVUS raised the suspicion of endometrial polyps. Additionally, the incidence of pregnancies obtained within the first 12 months after the hysteroscopic removal of endometrial polyps was recorded. Results. Out of the cohort of 97 infertile patients, endometrial polyps were suspected in 33 patients. Before hysteroscopy, seven patients additionally underwent a sonohysterography (SHG) procedure. Abnormal uterine bleeding was the primary clinical manifestation (21 cases; 63.63%). EPs were histologically confirmed in 31 cases, and leiomyoma, in two cases. Of the 31 EPs cases, in 20 cases (64.51%) the localization was at the utero-tubal junction. Out of the 30 patients diagnosed with EPs and where the follow-up was possible, 18 individuals, constituting 60% of the group, successfully attained intrauterine pregnancies within the initial 12 months following their hysteroscopic procedure. Conclusions. Our study revealed a significant improvement in reproductive outcomes within the first year following EP resection. The prevalence of endometrial polyps has increased due to improved ultrasound techniques. SHG can potentially increase the ultrasound detection of endometrial polyps, especially in cases where the imagistic information is unclear. Nonetheless, hysteroscopy, known for its high diagnostic accuracy, remains the gold standard. Our research supports the importance of hysteroscopy for uterine cavity assessment and lesion management, and it highlights the increased chances of pregnancy after the lesion’s removal.