Hysteroscopic Removal Of Endometrial Polyps Research Articles

Hysteroscopic management of subfertility in cases with suspected endometrial polyps

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.

The effects of hysteroscopic morcellation of endometrial polyps on frozen embryo transfer outcomes

Objective(s)To determine if hysteroscopic removal of endometrial polyps, specifically via morcellation of polyps, affects implantation rate (IR), clinical pregnancy rate (CPR), spontaneous abortion (SAB) rate, and live birth rate (LBR) in first frozen embryo transfer (FET) cycles. Study DesignRetrospective chart review, with data abstracted from the charts of all first autologous oocyte frozen embryo transfer (FET) cases (n = 135) at a single fertility center from January 2018 through June 2020. Subjects were grouped into (A) hysteroscopic polypectomy prior to first FET (n = 25) or (B) no hysteroscopic polypectomy prior to first FET (n = 110). The primary outcome was live birth rate (LBR). Secondary outcomes were implantation rate (IR), clinical pregnancy rate (CPR), and spontaneous abortion (SAB) rate. ResultsWe found no difference between the groups in terms of the primary outcome (LBR) or the secondary outcomes IR, CPR, and SAB rate. Conclusion(s)The data analyzed here suggest that hysteroscopic morcellation of endometrial polyps has no adverse effect on IR, SAB rate, CPR, or LBR among first FET cases after this type of polypectomy.

Reproductive outcomes following Hysteroscopic Removal of endometrial polyps of different location, number, and size in patients with infertility

Bɑсkgrouոd: Һystеrosсopiс rеsесtioո is ɑ rеlɑtivеly sɑfе ɑոd simplе proсеdurе wһiсһ еffесtivеly rеmovеs polyps; һowеvеr, еոdomеtriɑl polyps сɑո rесur. Studiеs һɑvе suggеstеd rесurrеոсе rɑtеs of up to 46%, ɑոd tһеrеforе it is importɑոt to idеոtify risk fɑсtors ɑssoсiɑtеd witһ rесurrеոсе. Objесtivе: To ɑssеss tһе prеgոɑոсy rɑtе ɑftеr һystеrosсopiс polypесtomy iո iոfеrtility pɑtiеոts witһ еոdomеtriɑl polyps to сompɑrе prеgոɑոсy rɑtе ɑmoոg subgroups witһ polyps of diffеrеոt loсɑtioոs, ոumbеr ɑոd sizе. Pɑtiеոts ɑոd Mеtһods: These Prospесtivе Сoһort Study oո 60 сɑsеs were сoոduсtеd ɑt tһе dеpɑrtmеոt of obstеtriсs & gyոесology Sɑyеd Gɑlɑl Uոivеrɑity һospitɑl bеtwееո Mɑy 2017 ɑոd ɑpril 2018. Pɑtiеոts witһ uոеxplɑiոеd iոfеrtility. two groups. Rеsults: Iո our study wе сompɑrе tһе prеgոɑոсy rɑtе ɑссordiոg to polyp сһɑrɑсtеristiсs suсһ ɑs loсɑtioո, sizе ɑոd ոumbеr. ɑlso wе study tһе rеproduсtivе outсomе of һystеrosсopy iո two groups: 1st group witһout iոtrɑutеriոе lеsioո. 2 - 2ոd group witһ еոdomеtriɑl polyps. ɑոd wе fouոd tһɑt: tһеrе is ոo stɑtistiсɑlly dеfеrеոсе bеtwееո tһе two groups tһе p-vɑluе is 0.40654. Wе fouոd ɑ ոoո sigոifiсɑոt positivе сorrеlɑtioոs bеtwееո Prеgոɑոсy outсomе ɑոd ոumbеr of polyps witһ p-vɑluе 0.71, ɑ ոoո sigոifiсɑոt positivе сorrеlɑtioոs bеtwееո Prеgոɑոсy outсomе ɑոd sizе of polyps witһ p-vɑluе 0.456 ɑոd ɑ ոoո sigոifiсɑոt ոеgɑtivе сorrеlɑtioոs bеtwееո Prеgոɑոсy outсomе ɑոd sitе of polyps. Conclusion: Wе fouոd tһɑt tһеrе is ոo stɑtisticɑlly dеfеrеոcе bеtwееո tһе two groups. Wе fouոd ɑ ոoո sigոificɑոt positivе corrеlɑtioոs bеtwееո Prеgոɑոcy outcomе ɑոd ոumbеr of polyps, , sizе of polyps ɑոd ,sitе of polyps

Reproductive outcomes following Hysteroscopic Removal of endometrial polyps of different location, number, and size in patients with infertility

Reproductive outcomes following Hysteroscopic Removal of endometrial polyps of different location, number, and size in patients with infertility

Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities.

Observational studies suggest higher pregnancy rates after the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions, which are present in 10% to 15% of women seeking treatment for subfertility. To assess the effects of the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions suspected on ultrasound, hysterosalpingography, diagnostic hysteroscopy or any combination of these methods in women with otherwise unexplained subfertility or prior to intrauterine insemination (IUI), in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). We searched the following databases from their inception to 16 April 2018; The Cochrane Gynaecology and Fertility Group Specialised Register, the Cochrane Central Register of Studies Online, ; MEDLINE, Embase , CINAHL , and other electronic sources of trials including trial registers, sources of unpublished literature, and reference lists. We handsearched the American Society for Reproductive Medicine (ASRM) conference abstracts and proceedings (from 1 January 2014 to 12 May 2018) and we contacted experts in the field. Randomised comparison between operative hysteroscopy versus control for unexplained subfertility associated with suspected major uterine cavity abnormalities.Randomised comparison between operative hysteroscopy versus control for suspected major uterine cavity abnormalities prior to medically assisted reproduction.Primary outcomes were live birth and hysteroscopy complications. Secondary outcomes were pregnancy and miscarriage. Two review authors independently assessed studies for inclusion and risk of bias, and extracted data. We contacted study authors for additional information. Two studies met the inclusion criteria.1. Randomised comparison between operative hysteroscopy versus control for unexplained subfertility associated with suspected major uterine cavity abnormalities.In women with otherwise unexplained subfertility and submucous fibroids, we were uncertain whether hysteroscopic myomectomy improved the clinical pregnancy rate compared to expectant management (odds ratio (OR) 2.44, 95% confidence interval (CI) 0.97 to 6.17; P = 0.06, 94 women; very low-quality evidence). We are uncertain whether hysteroscopic myomectomy improves the miscarriage rate compared to expectant management (OR 1.54, 95% CI 0.47 to 5.00; P = 0.47, 94 women; very low-quality evidence). We found no data on live birth or hysteroscopy complication rates. We found no studies in women with endometrial polyps, intrauterine adhesions or uterine septum for this randomised comparison.2. Randomised comparison between operative hysteroscopy versus control for suspected major uterine cavity abnormalities prior to medically assisted reproduction.The hysteroscopic removal of polyps prior to IUI may have improved the clinical pregnancy rate compared to diagnostic hysteroscopy only: if 28% of women achieved a clinical pregnancy without polyp removal, the evidence suggested that 63% of women (95% CI 45% to 89%) achieved a clinical pregnancy after the hysteroscopic removal of the endometrial polyps (OR 4.41, 95% CI 2.45 to 7.96; P < 0.00001, 204 women; low-quality evidence). We found no data on live birth, hysteroscopy complication or miscarriage rates in women with endometrial polyps prior to IUI. We found no studies in women with submucous fibroids, intrauterine adhesions or uterine septum prior to IUI or in women with all types of suspected uterine cavity abnormalities prior to IVF/ICSI. Uncertainty remains concerning an important benefit with the hysteroscopic removal of submucous fibroids for improving the clinical pregnancy rates in women with otherwise unexplained subfertility. The available low-quality evidence suggests that the hysteroscopic removal of endometrial polyps suspected on ultrasound in women prior to IUI may improve the clinical pregnancy rate compared to simple diagnostic hysteroscopy. More research is needed to measure the effectiveness of the hysteroscopic treatment of suspected major uterine cavity abnormalities in women with unexplained subfertility or prior to IUI, IVF or ICSI.

Hysteroscopic Endometrial Polypectomy with Manual Vacuum Aspiration Compared to Mechanical Morcellation

To examine the effectiveness of hysteroscopy plus manual vacuum aspiration (MVA) for endometrial polypectomy compared with hysteroscopic morcellation. Retrospective cohort study (Canadian Task Force classification II-2). Duke University Medical Center database. Women who underwent hysteroscopic removal of endometrial polyps performed by Duke Fertility Center faculty physicians between January 1, 2015, and January 29, 2018, using either hysteroscopy plus MVA or hysteroscopic morcellation. The 2 groups were compared using the χ2 or Fisher's exact test, Student's t test, and multivariable regression analysis. The primary outcome was the duration of the procedure. Secondary outcomes were fluid deficit, rate of complete polyp resection, estimated blood loss, and operative complications. A total of 102 women undergoing endometrial polypectomy were identified. Patients in whom polyps were removed using only a hysteroscopic grasper and/or scissors (n = 31); patients who underwent an additional simultaneous procedure, such as laparoscopy (n = 12); and patients in whom the duration of the procedure was not recorded (n = 2) were excluded. Among the remaining 57 patients, 28 underwent hysteroscopy plus MVA and 29 underwent hysteroscopic morcellation. The mean duration of procedure was longer for hysteroscopic morcellation compared with hysteroscopy plus MVA (32 ± 10 minutes vs 20 ± 6 minutes; p = .04), and this difference remained significant after adjusting for age, body mass index, surgeon, and number and size of polyps. Mean fluid deficit was greater for morcellation than for hysteroscopy plus MVA (277 ± 204 mL vs 51 ± 97 mL; p < .001). Complete polyp resection was possible in all patients; however, the use of a hysteroscopic scissors and grasper was required for 1 patient in the MVA group. Estimated blood loss was minimal in all cases, and there were no operative complications. Hysteroscopy plus MVA is an effective method for removing large or multiple endometrial polyps, with outcomes comparable to hysteroscopic morcellation.

Spontaneous Pregnancy Rate after Hysteroscopic Removal of Endometrial Polyps in Infertility Patients : Experience at King Hussein Medical Center

Spontaneous Pregnancy Rate after Hysteroscopic Removal of Endometrial Polyps in Infertility Patients : Experience at King Hussein Medical Center

Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities.

Observational studies suggest higher pregnancy rates after the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions, which are detectable in 10% to 15% of women seeking treatment for subfertility. To assess the effects of the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions suspected on ultrasound, hysterosalpingography, diagnostic hysteroscopy or any combination of these methods in women with otherwise unexplained subfertility or prior to intrauterine insemination (IUI), in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). We searched the Cochrane Menstrual Disorders and Subfertility Specialised Register (8 September 2014), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2014, Issue 9), MEDLINE (1950 to 12 October 2014), EMBASE (inception to 12 October 2014), CINAHL (inception to 11 October 2014) and other electronic sources of trials including trial registers, sources of unpublished literature and reference lists. We handsearched the American Society for Reproductive Medicine (ASRM) conference abstracts and proceedings (from January 2013 to October 2014) and we contacted experts in the field. Randomised comparisons between operative hysteroscopy versus control in women with otherwise unexplained subfertility or undergoing IUI, IVF or ICSI and suspected major uterine cavity abnormalities diagnosed by ultrasonography, saline infusion/gel instillation sonography, hysterosalpingography, diagnostic hysteroscopy or any combination of these methods. Primary outcomes were live birth and hysteroscopy complications. Secondary outcomes were pregnancy and miscarriage. Two review authors independently assessed studies for inclusion and risk of bias, and extracted data. We contacted study authors for additional information. We retrieved 12 randomised trials possibly addressing the research questions. Only two studies (309 women) met the inclusion criteria. Neither reported the primary outcomes of live birth or procedure related complications. In women with otherwise unexplained subfertility and submucous fibroids there was no conclusive evidence of a difference between the intervention group treated with hysteroscopic myomectomy and the control group having regular fertility-oriented intercourse during 12 months for the outcome of clinical pregnancy. A large clinical benefit with hysteroscopic myomectomy cannot be excluded: if 21% of women with fibroids achieve a clinical pregnancy having timed intercourse only, the evidence suggests that 39% of women (95% CI 21% to 58%) will achieve a successful outcome following the hysteroscopic removal of the fibroids (odds ratio (OR) 2.44, 95% confidence interval (CI) 0.97 to 6.17, P = 0.06, 94 women, very low quality evidence). There is no evidence of a difference between the comparison groups for the outcome of miscarriage (OR 0.58, 95% CI 0.12 to 2.85, P = 0.50, 30 clinical pregnancies in 94 women, very low quality evidence). The hysteroscopic removal of polyps prior to IUI can increase the chance of a clinical pregnancy compared to simple diagnostic hysteroscopy and polyp biopsy: if 28% of women achieve a clinical pregnancy with a simple diagnostic hysteroscopy, the evidence suggests that 63% of women (95% CI 50% to 76%) will achieve a clinical pregnancy after the hysteroscopic removal of the endometrial polyps (OR 4.41, 95% CI 2.45 to 7.96, P < 0.00001, 204 women, moderate quality evidence). A large benefit with the hysteroscopic removal of submucous fibroids for improving the chance of clinical pregnancy in women with otherwise unexplained subfertility cannot be excluded. The hysteroscopic removal of endometrial polyps suspected on ultrasound in women prior to IUI may increase the clinical pregnancy rate. More randomised studies are needed to substantiate the effectiveness of the hysteroscopic removal of suspected endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions in women with unexplained subfertility or prior to IUI, IVF or ICSI.

Opportunities and Risk Factors for Premalignant and Malignant Transformation of Endometrial Polyps: Management Strategies

Study Objective To estimate the prevalence of benign, premalignant, and malignant endometrial polyps and the associated clinical risk factors for premalignant and malignant endometrial polyps. Design Retrospective study (Canadian Classification II-3). Setting Teaching hospital. Patients Seven hundred sixty-six patients with endometrial polyps. Interventions Hysteroscopic removal of endometrial polyps. Measurements and Main Results Patient clinical data were identified and analyzed. Frequency of premalignant and malignant histopathologic features in endometrial polyps was calculated. Clinical risk factors for premalignant and malignant endometrial polyps were analyzed. Endometrial polyps were histologically benign in most patients (96.21%). Hyperplasia with atypia in a polyp (premalignant polyp) was found in 3.26% of patients, and endometrial carcinoma in a polyp (malignant polyp) was detected in only 0.52 % of patients. Independent variables that were significantly related to premalignant and malignant polyps (all p <.05) in a binary logistic regression analysis included polyp diameter (odds ratio [OR], 2.93; 95% confidence interval [CI], 1.191–7.20), menopause status (OR, 4.85; 95% CI, 2.09–11.27), and abnormal uterine bleeding (OR, 3.97; 95% CI, 1.71–9.18). Conclusion Polyp diameter larger than 1.0 cm, menopause status, and abnormal uterine bleeding may increase the risk of premalignant and malignant endometrial polyps.

Endometrial Polyps and the Risk of Atypical Hyperplasia on Biopsies of Unremarkable Endometrium: A Study on 694 Patients With Benign Endometrial Polyps

The objective of our study was to examine the relationship between benign endometrial polyps and the underlying endometrium, analyzing factors associated with endometrial hyperplasia with and without atypia. Six hundred and ninety-four consecutive patients with benign endometrial polyps underwent hysteroscopic removal of the polyps combined with 2 biopsies of unremarkable endometrium. Hysteroscopic removal of endometrial polyps with 2 endometrial biopsies far from the base of the polyp were performed. The weight of each polyp was determined. Multivariable logistic regression analysis was used examining factors potentially associated with endometrial hyperplasia with and without atypia on endometrial biopsies. Overall, 18% of women had hyperplasia without atypia and 7.3% had atypia (with simple/complex hyperplasia) on hysteroscopically unremarkable endometrium. In postmenopause, 21.6% had hyperplasia without atypia, 12% atypia, and 1.2% adenocarcinoma on the sampled endometrium. At multivariable analysis, postmenopausal women with larger polyps had a 3.6-fold higher likelihood of atypia (odds ratio=3.6; 95% confidence interval: 1.3-10.3); in premenopause the likelihood of atypia was significantly associated with polyp weight and age above 40 years. Our findings suggest that important endometrial lesions are not always evident by hysteroscopic visualization. Therefore, endometrial biopsies should not be limited only to hysteroscopically evident lesions. Polypectomy should be combined with a histopathologic evaluation of the background endometrium, particularly in women with higher-risk characteristics.

The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review

Although hysteroscopy is frequently used in the management of subfertile women, a systematic review of the evidence on this subject is lacking. We summarized and appraised the evidence for the benefit yielded by this procedure. Our systematic search was limited to randomized and controlled studies. The QUOROM and MOOSE guidelines were followed. Language restrictions were not applied. We identified 30 relevant publications. Hysteroscopic removal of endometrial polyps with a mean diameter of 16 mm detected by ultrasound doubles the pregnancy rate when compared with diagnostic hysteroscopy and polyp biopsy in patients undergoing intrauterine insemination, starting 3 months after the surgical intervention [relative risk (RR) = 2.3; 95% confidence interval (CI): 1.6-3.2]. In patients with one fibroid structure smaller than 4 cm, there was a marginally significant benefit from myomectomy when compared with expectant management (RR = 1.9; 95% CI: 1.0-3.7). Hysteroscopic metroplasty for septate uterus resulted in fewer pregnancies in patients with subfertility when compared with those with recurrent pregnancy loss (RR = 0.7; 95% CI: 0.5-0.9). Randomized controlled studies on hysteroscopic treatment of intrauterine adhesions are lacking. Hysteroscopy in the cycle preceding a subsequent IVF attempt nearly doubles the pregnancy rate in patients with at least two failed IVF attempts compared with starting IVF immediately (RR = 1.7; 95% CI: 1.5-2.0). Scarce evidence on the effectiveness of hysteroscopic surgery in subfertile women with polyps, fibroids, septate uterus or intrauterine adhesions indicates a potential benefit. More randomized controlled trials are needed before widespread use of hysteroscopic surgery in the general subfertile population can be justified.

Histopathologic features and risk factors for benignity, hyperplasia, and cancer in endometrial polyps

Objective: The purpose of this study was to determine the rate of benign, hyperplastic, and malignant endometrial polyps and whether clinical data can predict histopathologic outcome. Study Design: Five hundred nine patients with endometrial polyps who consecutively underwent hysteroscopic removal of endometrial polyps over 48 months were identified from our gynecologic oncology surgical database. Medical reports provided clinical data. Statistical analysis was performed. Results: Histologically, 358 polyps (70.3%) were benign; 131 polyps (25.7%) had simple or complex endometrial hyperplasia, 16 polyps (3.1%) had hyperplasia with atypia, and 4 polyps (0.8%) were cancerous. Polyps were divided into group A and group B, according to the risk of malignancy (group A, benign; group B, atypical hyperplastic and cancerous). Age, menopause status, and hypertension were associated significantly with group B. Conclusion: Endometrial polyps rarely become malignant, but hyperplastic changes are more common. Age, menopause status, and hypertension may increase the risk of premalignant and malignant polyps. To achieve complete removal of the polyp and a reliable histologic analysis, operative hysteroscopy should be offered to symptomatic patients or to patients with risk factors. (Am J Obstet Gynecol 2003;188:927-31.)

A randomized prospective study of the use of endometrial ablation for prevention of recurrent endometrial polyps in breast cancer patients receiving tamoxifen

Objective: To assess the roles of endometrial ablation in prevention of recurrence of tamoxifen-associated endometrial polyps in breast cancer patients. Design: A randomized prospective study of tamoxifen-treated patients who underwent hysteroscopic removal of endometrial polyps with or without simultaneous resection of the endometrium. Materials and Methods: Twenty consecutive women (aged 43–61 years) undergoing hysteroscopic removal of tamoxifen-associated endometrial polyps were randomized via a computer-generated random table to undergo or not to undergo concomitant endometrial ablation. All patients had undergone endometrial sampling prior to the procedure. The patients were followed for at least 18 months (range 18–24 months). The follow-up included transvaginal ultrasonography every 6 months and hysteroscopy when endometrial irregularity was noted. The main outcome variable was recurrence of endometrial polyps while the occurrence of uterine bleeding was noted. Results: In the 10 study group women, who underwent endometrial ablation, only 1 patient had a 1 × 1 cm endometrial polyp diagnosed and removed during the follow-up period. Seven of the study women remained amenorrheic, and 3 experienced spotting a few days every month. In the control group, a recurrent endometrial polyp, necessitating hysteroscopic removal, was diagnosed postoperatively in 6 women (two-tailed Fisher’s Exact test; P < .06). Conclusion: Recurrence of endometrial polyps, one of the most common problems in breast cancer patients receiving long-term treatment with tamoxifen, can be significantly reduced by performing endometrial ablation at the time of hysteroscopic removal of the polyp. The possible risk of occult endometrial cancer is yet to be determined.

Fertility outcome after outpatient hysteroscopic removal of endometrial polyps and submucous fibroids

We assessed the value of hysteroscopic removal of polyps and submucous fibroids from women requesting fertility treatment. Between December 1991 and June 1995 we recruited 146 women (age 28-44 yrs) with such lesions who were undergoing investigations for in vitro fertilization (IVF). In most of them, intrauterine pathology was not the sole cause of subfertility. In all women the lesions were diagnosed by hysterosalpingography or vaginal ultrasound examination with fluid instillation and subsequent hysteroscopy. In 122 patients the lesion was removed hysteroscopically with the resectoscope under light sedation in an outpatient setting. No complications occurred during or after surgery. The remaining 24 patients with polyps smaller than 2 cm underwent IVF treatment directly. In the 122 women who proceeded to treatment, further diagnostic office hysteroscopy was also performed. Group A consisted of 82 women with up to three polyps (65 <2 cm, 17 >2 cm); group B, 40 women with up to five fibroids smaller than 4 cm; and group C, 24 women with ultrasound diagnosis of polyps smaller than 2 cm for whom no treatment was carried out. In groups A and B the diagnosis was confirmed histologically. All these women subsequently underwent IVF. In group A (<2 cm polyps) the pregnancy rate was 28% per embryo transfer, and in the rest of group A (>2 cm) it was 40%. In group B the pregnancy rate was 46% and in group C 35%. We think that polyps less than 2 cm diameter do not require removal before IVF and do not affect the outcome of the subsequent pregnancy.