The effect of localization and histological verification of endometrial polyps on infertility (original) (raw)
Related papers
Journal of the Royal Medical Services, 2018
Objective: To evaluate the effectiveness of hysteroscopic trans-cervical resection of endometrial polyps in improving pregnancy rates. Methods: This retrospective study at King Hussein Medical Center from March 2006 to January 2012. One hundred and 25 patients were included with a diagnosis of primary or secondary infertility for a minimum of 2 years. Endometrial polyps were diagnosed by trans-vaginal Ultrasound scan and confirmed later by hysteroscopy. The inclusion criteria were age under 38 years, menstrual irregularities for at least 6 months, no other cause of infertility was found after diagnostic workup of the couples, minimum 2 years of infertility and 18 months of follow-up with attempts to conceive after hysteroscopic polypectomy. All polyps were larger than 1.5 cm. The effect of the different sizes of the polyps was not evaluated in our study. Results: All 125 Patients had endometrial polyps on transvaginal scans and confirmed at hysteroscopic removal and histological examination. Among patients of the study group, there were no significant differences in age, type or length of infertility, or follow-up period after the procedure. The mean size of the endometrial polyps was 3.0 cm ± 0.5cm. Sixty patients had endometrial polyp ≤ 2.8 cm and 65 patients had bigger or multiple endometrial polyps. Following the procedure, menstrual irregularity was back to normal in 90% of patients. After the procedure, the spontaneous pregnancy rate was 80% (100 patients of the total number of patients) and delivery at term rate was 70% (70 patients out of the 100 patients who conceived). Spontaneous abortion rate in the first trimester of pregnancy was 12% (12 patients) of the total number of pregnant patients. Type of infertility did not affect fertility rates after hysteroscopic polypectomy. There were no complications related to the procedure in the study patients and only 13 patients (10.5%) had recurrence of their menstrual irregularities. Conclusion: Fertility rate in patients with endometrial polyps and menstrual irregularities with no other cause to explain their infertility is significantly improved with trans-cervical polypectomy. The procedure is also safe with low recurrence rate.
Surgical intervention versus expectant management for endometrial polyps in subfertile women
The Cochrane database of systematic reviews, 2014
Endometrial polyps, which are benign growths of the endometrium, may be a factor in female subfertility. Possible mechanisms include physical interference with gamete transport, alteration of the endometrial milieu and unresponsiveness to the cyclical global endometrial changes. As such polyps remain mostly asymptomatic, their diagnosis is often incidental during routine investigations prior to embarking on assisted reproductive treatment. Transvaginal sonography, hysterosalpingography and saline infusion sonography are the diagnostic tools most commonly employed. However, hysteroscopy remains the gold standard for diagnosis, as well as for treatment. Due to the possible effect of endometrial polyps on fertility, their removal prior to any subfertility treatment is widely practiced. To determine the effectiveness and safety of removal of endometrial polyps in subfertile women. Electronic databases were searched, including the Cochrane Menstrual Disorders and Subfertility Group Speci...
BACKGROUND: It was our intention to determine whether hysteroscopic polypectomy before intrauterine insemination (IUI) achieved better pregnancy outcomes than no intervention. METHODS: A total of 215 infertile women from the infertility unit of a university tertiary hospital with ultrasonographically diagnosed endometrial polyps (EP) undergoing IUI were randomly allocated to one of two pretreatment groups using an opaque envelope technique with assignment determined by a random number table. Hysteroscopic polypectomy was performed in the study group. Diagnostic hysteroscopy and polyp biopsy was performed in the control group. RESULTS: Total pregnancy rates and time for success in both groups after four IUI cycles were compared by means of contingency tables and life-table analysis. A total of 93 pregnancies occurred, 64 in the study group and 29 in the control group. Women in the study group had a better possibility of becoming pregnant after polypectomy, with a relative risk of 2.1 (95% confidence interval 1.5-2.9). Pregnancies in the study group were obtained before the first IUI in 65% of cases. CONCLUSIONS: These data suggest that hysteroscopic polypectomy before IUI is an effective measure.
based medicine, the Belgian branch of the Cochrane Collaboration, Capucijnenvoer 33, blok J, 3000 Leuven. Abstract Background: The role of reproductive surgery is declining due to the widespread availability of assisted reproductive technology, but an evidence-based fundament for this decline is lacking. We therefore performed a systematic review of the literature. Methods: We searched MEDLINE, EMBASE and the Cochrane Library for randomised trials evaluating laparoscopic or hysteroscopic interventions in subfertile women, studying pregnancy or live birth rates. We present an overview of the results and quality of the detected studies. Results: The methodological quality of the 63 detected studies was mediocre. The laparoscopic treatment of minimal/ mild endometriosis might increase the pregnancy rate but the two major studies report conflicting results. Excision of the endometriotic cyst wall increases the spontaneous conception rate (RR 2.8, 95% CI 1.4-5.5). Laparoscopic ovarian dr...
Reproductive surgery in infertility
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2017
Background: With recent improvements in the assisted reproductive technology (ART), there has been a growing tendency that bypasses diagnostic laparohysteroscopy and proceeds directly to ART. Therefore, the value of diagnostic laparohysteroscopy in current fertility practice is under debate. In the present study, we evaluated the usefulness of diagnostic laparoscopy and hysteroscopy for patients with infertility.Methods: This retrospective study was conducted at Safal Hospital, Nagpur from January 2017 to July 2017. 80 patients were selected for this study who had undergone diagnostic laparohysteroscopy for infertility.Results: In present study, out of 80 patients studied, 66.25% patients had normal hysteroscopy findings, in 10% of patients, tubal cannulation was done for cornual block, in 6.25% of patients, resection of uterine septum was done, adhesiolysis for asherman’s syndrome was done in 5% of patients, endometrial polyp was removed in 5% of patients, 2.5% patients had resecti...
Hysteroscopic polypectomy in 240 premenopausal and postmenopausal women
Fertility and Sterility, 2005
Objective: To ascertain the therapeutic efficacy and safety of hysteroscopic polypectomy in 240 premenopausal and postmenopausal patients. Design: Retrospective study. Setting: Tertiary university hospital. Patient(s): Two hundred forty patients with intrauterine endometrial polyps, who mostly suffered from abnormal uterine bleeding and infertility. Intervention(s): Hysteroscopic polypectomy using various instruments including microscissors, grasping forceps, or electrosurgery either with a monopolar probe or a resectoscope. Main Outcome Measure(s): Operating time, amount of glycine absorption, complications, resumption of normal menstruation, cumulative pregnancy rate, and recurrent rate of polyps after hysteroscopic surgery. Result(s): Resectoscopic polypectomy needed more operating time, had more glycine absorption and complications, but less recurrence than other hysteroscopic techniques. The resectoscope had a 0% recurrence rate and that grasping forceps had a 15% recurrence rate. A total of 21 (8.7%) complications occurred, but no major complications were noted. After long-term follow-up of 9 years and 2 months, those with abnormal uterine bleeding resumed normal menstruation in 93.1% and those with infertility had a cumulative pregnancy rate of 42.3%. There was no statistical difference in reproductive outcome between patients having polyps Յ 2.5 cm and Ͼ2.5 cm. Conclusion(s): We found hysteroscopic polypectomy to be effective, safe, minimally invasive procedure with low rate and mild complications. Restoration of reproductive ability did not depend on the size of the removed lesion. Resectoscopic surgery is more preferable to prevent recurrence of polyps.
Minimally invasive exploration of the female reproductive tract in infertility
Reproductive BioMedicine Online, 2002
The aim of the study: to assess the effectiveness of advanced minimally invasive laparoscopic surgical interventions in the treatment of women with infertility due to a benign structural changes of the ovaries. Material and methods: A survey of 270 patients with infertility who underwent in operation in gynecology department of obstetric complex № 9 in Tashkent in 2014-2016. The average age of patients was 25.8±098 years. Primary infertility suffered 160 (59.2%), the secondary-110 (40.7%) patients. The duration of infertility was from 2 to 9 years. To clarify the causes of infertility all patients were conducted a comprehensive survey that included clinical, laboratory, hormonal, bimanual, microbiological examination, transvaginal ultrasound scan, hysterosalpingography, laparoscopy and hysteroscopy. Endosurgical treatment of patients with infertility was carried out by two methods: laparoscopic and hysteroscopic. Results: As a result of investigation of 120 women (44.4%) identified infertility due to follicular ovarian cysts and 120 (44.4%) of infertility associated with impaired ovulation-polycystic ovary syndrome (PCOS). It should be noted that 80 infertile women (30.0%) mentioned a combination of 2 to 3 factors that violate the reproductive function. During laparoscopy the patients with infertility due to a benign structural changes of the ovaries, revealed various pathological changes in the fallopian tubes: 24 (10%) had adhesions in the fimbria tract, 6 (2.5%) was determined by the obstruction of the fallopian tube in the proximal. 3 patients (1.25%) had determined adhesion process 2-3 degrees of severity. When hysteroscopic study, 30 women with benign structural changes of the ovaries 26 (10.8%) of women detected intrauterine pathology: chronic endometritis-11 (4.6%), synechia in the uterus-5 (2.1%), endometrial hyperplasia-in 4 (1.6%), foreign bodies of the uterus in the form of silk sutures after cesarean section 6 (2.5%). Conclusions: The effectiveness of resection of the ovaries in PCOS is increased 1.5 times compared to electrocauterisation. The restoration of women fertility in with benign structural changes of the ovaries amounted to 87.5%, undergoing endosurgical operation in PCOS and cystectomy. A differentiated approach to the choice of method of surgical intervention depending on the kind of benign structural changes of the ovaries. Combined laparoscopy hysteroscopic study allows to identify and eliminate the causes of uterine infertility.
Endometrial polyps in infertility patients: The first study of their clinical characteristics
Clinical and experimental obstetrics & gynecology, 2018
Purpose: The study aim was to investigate clinical characteristics of endometrial polyps in women with and without infertility. Materials and Methods: Study included all patients of reproductive age who had a hysteroscopy due to endometrial polyps during 30 months. Patients were divided according to infertility problems. Detailed medical history was taken from all patients (age, BMI, parity, comorbidities, symptoms/signs, and polyp recurrence). On ultrasound scan, the polyp's largest diameter and endometrial thickness were assessed. During hysteroscopy localization of polyps and other intrauterine formations were registered. Removed polyps were histopathologically analyzed (size and histological type). Results: Study involved 257 patients (average 38.5 years of age), out of which 79 had infertility problem, while 178 patients constituted the control group. There were no significant differences regarding patient's BMI, age in decades, number of abortions, presence of comorbidities, taking hormone therapy, symptoms/signs, localization or diameters of polyps, polyp recurrence, other intrauterine findings, and histopathological types of polyps between women with and without infertility problems. Conclusion: Clinical characteristics of endometrial polyps are quite similar in women with and without infertility problems.