Uterine polyps consist of excess tissue which grows on the inner walls of a woman’s uterus. These polyps can develop in women of any age but usually affect women in their 40s and 50s. Doctors disagree on whether or not uterine polyps are a root cause of infertility.
What Do Polyps Do?
Uterine polyps feed on the hormone estrogen. The more estrogen a woman with uterine polyps has in her body, the more her polyps will grow. When uterine polyps get to be a certain size, they begin protruding into the uterine cavity. Polyps range in size from a few millimeters to several centimeters. They are usually attached to the wall of the uterus by a large base or by a thin stalk. In some cases, uterine polyps can slip down into the cervix (the opening of the uterus).
Some fertility experts believe that uterine polyps may cause infertility, but there are other doctors who disagree. Even those who accept the link between uterine polyps and infertility aren’t sure exactly how polyps cause fertility problems. One theory is that the uterine polyps disrupt the lining of the uterus (the endometrium). The uterine polyps may even reduce blood flow in parts of the endometrial lining. This disruption could possibly prevent a fertilized embryo from implanting in the endometrial lining. The polyps could also cause a miscarriage after the embryo has implanted. There is evidence to show that removing uterine polyps does boost fertility in previously infertile women. For example, one study found that 63% of women suffering from uterine polyps got pregnant via intrauterine insemination (IUI) after they had their polyps removed. This figure compares to only 28% of women with uterine polyps who got pregnant from IUI alone.
Studies have found that a woman who has polyps in her uterus has an increased chance of miscarriage after getting pregnant through in-vitro fertilization (IVF). For this reason, IVF doctors usually recommended that uterine polyps are removed before any fertilized embryos are transferred to a woman’s uterus.
Sometimes uterine polyps can be asymptomatic. Many women with uterine polyps are never bothered by their condition and don’t require treatment. When symptoms do occur, they include:
Irregular, unpredictable menstrual bleeding or vaginal bleeding after menopause
Heavy, painful periods
As mentioned above, some uterine polyps do not require treatment and may even go away by themselves. In general, treatment is given only if the patient is experiencing discomfort, if she is having difficulty getting pregnant or if the polyps are potentially cancerous.
Treatment methods include:
Hormone medication – drugs such as progestins and GnRH agonists can be used to block estrogen production and thereby shrink uterine polyps. These drugs induce an artificial state of menopause so the patient is unlikely (and not advised) to get pregnant until after the treatment is finished. Hormones may not be the answer for infertility patients because the uterine polyps tend to grow back when the treatment ends.
Surgical removal – a surgical procedure called a hysteroscopic polypectomy is used to take out uterine polyps. This is the treatment most likely to be offered to infertility patients. The doctor inserts his surgical instruments into the uterus via a hysteroscope (a device which helps him see into the uterus) and removes the polyps.
Hysterectomy – this surgical procedure involves the removal of the uterus. This is the most radical treatment used to remove uterine polyps and is usually performed only if the uterine polyps are cancerous. Obviously, once the uterus has been removed, it is not possible for the patient to become pregnant.