Incidence Of Endometrial Polyps Research Articles

Nonlinear correlation between serum vitamin D levels and the incidence of endometrial polyps in infertile women.

Are serum vitamin D levels associated with the incidence of endometrial polyps (EPs) in infertile patients? Serum 25(OH)D levels were nonlinearly correlated with the incidence of EPs in infertile women. EPs are a common condition that may affect the receptivity of the endometrium in women of reproductive age. Vitamin D regulates cell proliferation and differentiation, apoptosis, angiogenesis, anti-inflammation, and immunomodulation, in addition to its well-known functions in balancing calcium and phosphorus. Previous studies have shown that vitamin D concentrations are associated with reproductive outcomes, and that low vitamin D levels are associated with the incidence of colorectal polyps and nasal polyps. There is little evidence regarding the relationship between EPs and serum vitamin D levels. We conducted a cross-sectional study using data from Guangdong Women and Children Hospital from January 2019 to October 2023, enrolling 3107 patients. A total of 3107 infertile patients who underwent hysteroscopy were included in this study; 642 patients had endometrial polyps and 2465 had a normal uterine cavity. Hysteroscopy findings included risk of EPs, polyp size, percentage of multiple polyps, and incidence of chronic endometritis (CE). Serum vitamin D were assessed by measuring total 25(OH)D using chemiluminescence. According to international guideline recommendations for vitamin D deficiency, patients were divided into two groups: the <50 nmol/l group and the ≥50 nmol/l group. Univariable and multivariable logistic regression models, stratified analyses, and smooth curve fitting were used to examine the relationship between serum 25(OH)D levels and risk of EPs. Of all patients, 23.8% (740/3107) were vitamin D deficient (<50 nmol/l). The incidence of EPs was significantly higher in the 25(OH)D < 50 nmol/l group than in the ≥50 nmol/l group (24.9% vs 19.3%; P = 0.001). However, there were no differences in polyp size, proportion of multiple polyps, and presence of CE between the two groups. After controlling for confounders, 25(OH)D ≥ 50 nmol/l (compared with <50 nmol/l) was negatively associated with risk of EPs (adjusted OR, 0.733; 95% CI, 0.598-0.898). Other variables that had an impact on polyp incidence included BMI, type of infertility, CA125, and CD138-positive plasma cells. In addition, a linear regression model between age and serum 25(OH)D levels showed a positive linear association. Subgroup analyses were performed for different age groups, and the risk of EPs was significantly higher in the 25(OH)D < 50 nmol/l group than in the ≥50 nmol/l group, both in the younger subgroup (23.8% vs 19.1%) and in the older subgroup (28.0% vs 19.9%). The smooth curve fitting model showed a nonlinear correlation between 25(OH)D levels and risk of EPs (nonlinear P-value = 0.020), with an optimal threshold of 51.8 nmol/l for 25(OH)D levels. Moreover, subgroup smooth curve fitting models showed a nonlinear correlation between 25(OH)D levels and polyp risk in patients aged <35 years (nonlinear P-value = 0.010), whereas a linear correlation between 25(OH)D levels and polyp risk was found in patients aged ≥35 years (nonlinear P-value = 0.682). Caution should be exercised in interpreting our findings as this is a correlational study and causality cannot be inferred from our results. In addition, because of strict inclusion and exclusion criteria, our results may not be generalizable to unselected populations, including premenopausal women or women of other races. This study demonstrated for the first time that vitamin D deficiency is an independent risk factor for the incidence of EPs in infertile patients. Identifying modifiable risk factors (e.g. vitamin D deficiency) can help in the development of new strategies for treating polyps or to protect against polyp development. Further clinical intervention trials and laboratory studies are needed to evaluate the effect of vitamin D on the development of EPs and to elucidate the mechanisms. The study was funded by the National Natural Science Foundation of China (82101718) and Natural Science Foundation of Guangdong Province, China (2022A1515010776). No competing interest was involved in this study. N/A.

Impact of estrogen and progesterone receptor expression on the incidence of endometrial polyps.

Aim: We studied the association of estrogen receptor (ER) and progesterone receptor (PR) with endometrial polyp (EP) formation. Methods: A total of 129 EP patients and an equal number of disease-free women were evaluated for ER and PR expression in endometrial tissues. Correlation with EP incidence was analyzed, as well as diagnostic value via receiver operating characteristic curve. Results: ER expression was higher and PR was lower in patients than in controls (p <0.01). ER levels positively correlated with EP incidence, and PR negatively (p <0.01). Receiver operating characteristic curves gave ER an area under the curve of 0.6168 (95% CI: 0.5479-0.6856; p <0.0001) and PR 0.739 (95% CI: 0.6776-0.8003; p <0.0001). Conclusion: Imbalance in ER and PR expression associates with EPs formation, offering clinical insights into EP pathology.

Endometrial polyps and their insinuation in the pregnancy rates of patients undergoing ICSI-FET cycles: A retrospective cohort study

To study the effect of endometrial polyps in infertility patients and their insinuation in pregnancy rates in patients undergoing ICSI-FET cycles following polypectomy.This is a retrospective study in 345 infertility patients attending Reproductive center of Sudha Hospital, Erode. Infertile women with endometrial polyps diagnosed by transvaginal ultrasound were subjected to hysteroscopic polypectomy. Vitrified embryo transfer was done one to three months following polypectomy and the clinical pregnancy rates were analysed. The age, body mass index, the type of infertility (primary or secondary), duration of infertility, pattern of menstruation, were precisely evaluated. An endometrial polyp based on their location inside the uterine cavity is assessed by hysteroscopy and the significance of the polyp location with pregnancy rates is evaluated.Of the 345 women who underwent hysteroscopic polypectomy 229 became pregnant and 116 women were non pregnant in ICSI-FET cycles. There is a strong positive association between endometrial polypectomy and pregnancy rate in ICSI-FET cycles. The incidence of Endometrial Polyps in pregnant and non-pregnant group was not related to the age, gravida and parity. Pregnancy rate after polypectomy based on polyp location is statistically insignificant. Multiple polyps are common compared to solitary polyp. Polyps are more common in posterior uterine wall than anterior, lateral walls and uterotubal junction.Hysteroscopic polypectomy gives promising results in infertility patients undergoing ICSI cycles prior to vitrified embryo transfer and location of polyps does not determine the pregnancy outcomes.

Improving diagnosis and treatment for endometrial polyp

Background. The incidence of endometrial polyps has reached 25–35% making them the most common intrauterine pathology. Polyps account for every fourth hysteroscopy due to their association with abnormal uterine bleeding, infertility and malignancy risks. Absolute or relative hyperestrogenism are important factors in the development of endometrial polyp. Infectious and immune mechanisms have recently acquired special attention with the polyp pathogenesis.Objectives. Management optimisation of infertile patients with endometrial polyp through differentiated choice of postoperative therapy.Methods. We examined 90 patients of reproductive age (36.07 ± 6.14 years) with endometrial polyp and infertility conducting a comprehensive history analysis, assessment of reproductive function, extragenital and gynaecological pathology. Laboratory analyses comprised clinical and biochemical blood tests including vitamin and ferrum. Immunohistochemical endometrial estimators were CD16+, CD56+, HLA–DR(II)+.Results. Patients with endometrial polyp and infertility had frequent bacterial vaginosis (90.0%), pelvic inflammations and vaginitises (78.89% each); endometrial polyp relapse was 10.4-fold more frequent in patients with infertility I compared to infertility II. Killer cell (CD16+ and CD56+) and HLA-DR(II)+ counts grow in chronic endometrial inflammation. Chronic autoimmune endometritis exacerbated in 53.33%, chronic exacerbated endometritis or acute endometritis were observed in 46.67%. Therapy differentiated by immunohistochemistry allowed successful pregnancy in natural cycles in 60.9% of patients with infertility I and in 85.7% — with infertility II.Conclusion. The success rate of natural cycle pregnancy in patients of reproductive age with endometrial polyp after polypectomy is directly related to type of endometrial inflammation: chronic autoimmune, chronic exacerbated or acute endometritis. Immunohistochemical estimators can be used for differentiating therapy, which allowed a 70.3% pregnancy success rate.

Hysteroscopic Evaluation of Endometrial Changes in Breast Cancer Women with or without Hormone Therapies: Results from a Large Multicenter Cohort Study

The primary aim of our study was to investigate the incidence of endometrial pathologies, especially endometrial cancer, in women with breast cancer treated with tamoxifen (TAM), aromatase inhibitors (AIs), or receiving no treatment (NT). The secondary aim was to identify, in this cohort, ultrasonographic findings that represent robust indications for hysteroscopy and endometrial biopsy, to avoid unnecessary second-level diagnostic procedures. Multicenter retrospective cohort study (Clinical Trial ID: NCT03898947). Data were collected from different Italian centers: Regina Elena National Cancer Institute of Rome, Arbor Vitae Centre of Rome, Gaetano Martino University Hospital of Messina, and Villa Sofia-Cervello Hospital of Palermo. We selected and consecutively included patients with a history of breast cancer who had undergone hysteroscopy for ultrasonographic or clinical indications between January 2007 and December 2016. Diagnostic hysteroscopy with endometrial biopsy or operative hysteroscopy, when clinically indicated. A higher percentage of patients in the TAM and AI groups had a normal endometrium compared with those in the NT group, whereas the incidence of endometrial polyps was higher in the NT group than in the others; no significant differences were observed among the 3 groups for other benign conditions or for premalignant and malignant uterine diseases, such as endometrial atypical hyperplasia and adenocarcinoma. TAM treatment does not seem to be associated with a higher rate of endometrial cancer in women with breast cancer compared with women treated with AIs or NT.

Location of endometrial polyp and pregnancy rate in infertility patients

To assess endometrial polyp location and abnormal endometrial findings and their impact on pregnancy rate. Retrospective study. Reproductive clinic in Kanagawa, Japan. A retrospective study was conducted on 230 infertility patients who had an endometrial polyp, as suspected on the basis of ultrasound and as diagnosed by hysteroscopy. Polyps were excised by either polypectomy or curettage. All samples were examined for pathology. The endometrial cavity was subdivided into five area categories: uterotubal junction, anterior uterine wall, posterior uterine wall, lateral uterine wall, and multiple. The patients received < or =6 months of follow-up; pregnancy rates were compared between the five subdivisions. Pregnancy rates. The incidence of endometrial polyps was as follows, by location: uterotubal junction, 8.0%; posterior uterine wall, 32.0%; anterior uterine wall, 15.4%; lateral uterine wall, 9.2%; and multiple, 35.4%. The pregnancy rate after surgery was as follows, by location: uterotubal junction, 57.4%; posterior uterine wall, 28.5%; anterior uterine wall, 14.8%; lateral uterine wall, 18.8%; and multiple, 40.3%. Endometrial hyperplasia was found in 6.9% of the cases. The pregnancy rate after surgery at the uterotubal junction was significantly higher than that of other locations. Endometrial polyps are commonly found on the posterior wall of the uterus; however, excision of polyps that were located at the uterotubal junction significantly improved the pregnancy rate. Endometrial polyps should be categorized by both size and location.

Endometrial and ovarian safety of bazedoxifene (BZA) in the prevention of postmenopausal osteoporosis

Endometrial safety is a key concern with selective estrogen receptor modulators (SERMs). BZA is a novel SERM that showed no significant uterotropic effects in preclinical and small clinical studies. This study assessed the efficacy and endometrial/ovarian safety of BZA for the prevention of osteoporosis. A randomized, double-blind, placebo- and raloxifene (RLX)-controlled phase III clinical trial conducted at 101 sites in the United States and globally. Generally healthy, postmenopausal (≥1 year) women ≥45 years of age were randomized to receive BZA 10, 20, or 40 mg; RLX 60 mg; or placebo daily for 2 years. Exclusion criteria included endometrial hyperplasia or endometrial thickness >5 mm. The primary efficacy endpoint was change from baseline in lumbar spine (LS) bone mineral density (BMD) at 24 months. Endometrial and ovarian safety were evaluated based on double-wall endometrial thickness and ovarian volume assessed by transvaginal ultrasound (TVUS) at Months 6, 12, 18, and 24, and endometrial biopsies performed at Months 12 and 24. The presence of, or changes in, ovarian cysts compared to baseline was assessed. Of the 1583 women (mean age ± standard deviation [SE], 57.6 ± 6.5 years) who received ≥1 dose of study medication, 1014 (70.7%) had an intact uterus, and 963 (60.8%) had TVUS at baseline and ≥1 on-therapy timepoint. LS BMD was preserved with BZA 10, 20 and 40 mg relative to placebo (P<0.001). Endometrial thickness with BZA 10, 20, and 40 mg remained stable over 24 months (mean change from baseline [mm] ± SE, 0.05 ± 0.11, −0.01 ± 0.10, and −0.16 ± 0.11, respectively), and was not different from baseline, placebo (−0.23 ± 0.10 mm), or RLX (−0.05 ± 0.11). There were no cases of endometrial hyperplasia or malignancy with any dose of BZA (n = 414) or RLX (n = 147), and 1 case of endometrial malignancy with placebo (n = 139). The incidence of endometrial polyps at 24 months was similar among BZA 10, 20, and 40 mg (2.2%, 3.4%, and 2.3%, respectively), and not different from placebo (3.5%); a slightly higher incidence of polyps was reported with RLX (4.7%). There were no clinically important changes from baseline or differences between treatment groups in the number or size of ovarian cysts or ovarian volume. BZA exhibits an excellent endometrial and ovarian safety profile, preserves BMD, and is an important addition to the therapeutic armamentarium for the prevention of postmenopausal osteoporosis.

Location of the endometrial polyp and its pregnancy rate of infertility patients

To assess endometrial polyp location and abnormal endometrial findings and their impact on pregnancy rate. Retrospective study. A retrospective study was conducted on 230 infertility patients who had an endometrial polyp suspected ultrasound and diagnosed by hysteroscopy. Polyp was taken out by either polypectomy or curettage. All specimens were pathologically examined. The endometrial cavity was subdivided into five areas: utero-tubal junction, anterior uterine wall, posterior uterine wall, lateral uterine wall, and multiple. The patients received up to six months of follow-up; pregnancy rates were compared between the five subdivisions. The incidence of endometrial polyps by location was: utero-tubal junction, 8.0%; posterior uterine wall, 32.0%; anterior uterine wall, 15.4%; lateral uterine wall, 9.2%; and multiple, 35.4%. The pregnancy rate by location after operation was: utero-tubal junction, 57.4%; posterior uterine wall, 28.5%; anterior uterine wall, 14.8%; lateral uterine wall, 18.8%; and multiple, 40.3%, respectively. Endometrial hyperplasia was found in 6.9% of the cases. The pregnancy rate after operation in utero-tubal junction was significant higher than that of others. Endometrial polyps are commonly found on the posterior wall of the uterus; however, excision of polyps located at the utero-tubal junction significantly improved the pregnancy rate. Endometrial polyps should be categorized for both size and location.

Ovarian endometriosis associated with ovarian cancer and endometrial?endocervical polyps

To determine the prevalence of ovarian cancer and endometrial polyps in women with moderate and severe ovarian endometriosis. A retrospective analysis of 667 cases of moderate and severe endometriosis laparoscopically and histologically confirmed during the period 1997-2004. One hundred and ninety-three (29%) of cases were American Fertility Society (AFS) stage III (moderate endometriosis) and 473 (71%) were AFS stage IV (severe endometriosis). Ovarian cancer was diagnosed in 13 cases (2.0%), while an endometrial or endocervical polyp was identified in 35 cases (5.3%). The incidence of endometrial polyps in the group with moderate endometriosis tended to be higher (15/193, 7.8%) than in the group with severe endometriosis (20/473, 4.2%), and the same results were obtained in the ovarian cancer group (moderate: 6/193, 3.1%; severe: 7/473, 1.5%). However, neither of the two differences was statistically significant. Ovarian endometriosis may be associated with an increased incidence of both ovarian cancer and endometrial polyps. Careful evaluation for coexistent pathology should be undertaken in women with symptomatic endometriosis.

P-354: Clinical evidence of endometrial proliferation in infertile women with endometriosis

ObjectiveThe endometriosis is an estrogen-dependent disorder that can result in infertility. The cause-effect relationship between endometriosis and infertility is controversial. A Recent retrospective multicenter analysis reported cumulative pregnancy rate was correlated with endometriosis stage, and also high frequency of endometrial polyps was detected in endometriosis. The aim of this study was to evaluate the correlation between severity of endometriosis and incidence of endometrial polyps.DesignProspective clinical study.Materials and methodsThe study population consisted of 631 infertile women, including 433 women with endometriosis (study group) and 198 women without the disease (control group). The presence of endometriosis was documented by diagnostic or therapeutic laparoscopic operation and the disease severity was scored according to the American Fertility Society classification. We confirmed the endometrial polyps by pathologic examination after hysteroscopic polypectomy.ResultsThere was no significant difference between groups with regard to age, mean duration of infertility, hormonal profiles and the other component of basic infertility work-up study. Endometrial polyps were found in 273 women (273/433, 63.0%) with endometriosis and in 59 controls (59/198, 29.8%, p= 0.0000). The incidence of endometrial polyps differed significantly according to stage of endometriosis. The incidence of endometrial polyps were 77/142 (54.2%), 58/90 (64.4%), 73/108(67.6%, p<0.05), 66/93(71.0%, p<0.05) in endometriosis stage I, II, III, and IV. Although there appeared to be a positive correlation between stage of endometriosis and incidence of endometrial polyps, significant difference was found in only endometriosis stage III and IV.ConclusionThis results suggest that positive correlation between severity of endometriosis and incidence of endometrial polyps. We would like to recommend hysteroscopy if endometriosis is detected in a woman undergoing evaluation for infertility. ObjectiveThe endometriosis is an estrogen-dependent disorder that can result in infertility. The cause-effect relationship between endometriosis and infertility is controversial. A Recent retrospective multicenter analysis reported cumulative pregnancy rate was correlated with endometriosis stage, and also high frequency of endometrial polyps was detected in endometriosis. The aim of this study was to evaluate the correlation between severity of endometriosis and incidence of endometrial polyps. The endometriosis is an estrogen-dependent disorder that can result in infertility. The cause-effect relationship between endometriosis and infertility is controversial. A Recent retrospective multicenter analysis reported cumulative pregnancy rate was correlated with endometriosis stage, and also high frequency of endometrial polyps was detected in endometriosis. The aim of this study was to evaluate the correlation between severity of endometriosis and incidence of endometrial polyps. DesignProspective clinical study. Prospective clinical study. Materials and methodsThe study population consisted of 631 infertile women, including 433 women with endometriosis (study group) and 198 women without the disease (control group). The presence of endometriosis was documented by diagnostic or therapeutic laparoscopic operation and the disease severity was scored according to the American Fertility Society classification. We confirmed the endometrial polyps by pathologic examination after hysteroscopic polypectomy. The study population consisted of 631 infertile women, including 433 women with endometriosis (study group) and 198 women without the disease (control group). The presence of endometriosis was documented by diagnostic or therapeutic laparoscopic operation and the disease severity was scored according to the American Fertility Society classification. We confirmed the endometrial polyps by pathologic examination after hysteroscopic polypectomy. ResultsThere was no significant difference between groups with regard to age, mean duration of infertility, hormonal profiles and the other component of basic infertility work-up study. Endometrial polyps were found in 273 women (273/433, 63.0%) with endometriosis and in 59 controls (59/198, 29.8%, p= 0.0000). The incidence of endometrial polyps differed significantly according to stage of endometriosis. The incidence of endometrial polyps were 77/142 (54.2%), 58/90 (64.4%), 73/108(67.6%, p<0.05), 66/93(71.0%, p<0.05) in endometriosis stage I, II, III, and IV. Although there appeared to be a positive correlation between stage of endometriosis and incidence of endometrial polyps, significant difference was found in only endometriosis stage III and IV. There was no significant difference between groups with regard to age, mean duration of infertility, hormonal profiles and the other component of basic infertility work-up study. Endometrial polyps were found in 273 women (273/433, 63.0%) with endometriosis and in 59 controls (59/198, 29.8%, p= 0.0000). The incidence of endometrial polyps differed significantly according to stage of endometriosis. The incidence of endometrial polyps were 77/142 (54.2%), 58/90 (64.4%), 73/108(67.6%, p<0.05), 66/93(71.0%, p<0.05) in endometriosis stage I, II, III, and IV. Although there appeared to be a positive correlation between stage of endometriosis and incidence of endometrial polyps, significant difference was found in only endometriosis stage III and IV. ConclusionThis results suggest that positive correlation between severity of endometriosis and incidence of endometrial polyps. We would like to recommend hysteroscopy if endometriosis is detected in a woman undergoing evaluation for infertility. This results suggest that positive correlation between severity of endometriosis and incidence of endometrial polyps. We would like to recommend hysteroscopy if endometriosis is detected in a woman undergoing evaluation for infertility.