Case Report – Uterine Polyps as a cause in infertility

Summary:

The case study describes a patient who sought a second opinion and discovered that her uterine clot was actually a polyp.  It emphasizes the necessity of properly assessing the uterine cavity to ensure it is free of polyps before IVF treatments, as the presence of polyps can lead to infertility or affect pregnancy outcomes. The recommended management includes diagnostic hysteroscopy and polypectomy, highlighting that removing polyps can often resolve infertility issues.

Full details:

I had a patient who came to see me for second opinion.

The patient had IVF treatment at another clinic and was told that she had a clot in her uterus. However, after I reviewed her by performing a hysteroscopy *, I realised that the clot was in fact a polyp.

The other clinic was planning to do a frozen embryo transfer; however, the polyp was not removed which could ultimately affect the IVF result. The importance of the case is to highlight that the uterine cavity needs to be properly assessed and must be in good condition with no polyps. Any polyps should be removed to optimise the IVF outcome.

Firstly, the management includes diagnostic hysteroscopy to confirm the presence of the polyp by direct visualization, and secondly a successful polypectomy (removal of the polyp).

The ultrasound assessment is cycle dependent, and therefore important that is done prior to ovulation. However, a good ultrasound assessment is ultimately operator dependent. Hysteroscopy is the gold standard for the exclusion of uterine pathology,

Polyps are a common cause of infertility and recurrent pregnancy losses. In many cases, by just removing the polyp, the cause of infertility is corrected, and many patients even fall pregnant spontaneously without further IVF intervention.

In conclusion, and what we emphasise by this case, a uterine cavity must be clear of pathology, free of polyps for favourable IVF outcomes and/or spontaneous pregnancies. If present, the polyps, should be removed as in many cases might be the cause of infertility. This is the case for patients who are planning to do a frozen egg transfers (ET) which, with the presence of a polyp, ultimately will decrease the IVF success rate.

Figure 1: Hysteroscopy showing polyp in uterus

Figure 2: Hysteroscopy showing uterus after polypectomy

* Hysteroscopy is a clinical procedure enabling a physician to examine the interior of the uterus utilizing a slender, illuminated instrument known as a hysteroscope, which is introduced via the vaginal canal. This intervention is predominantly employed to diagnose and manage conditions such as abnormal uterine bleeding, uterine polyps, fibroids, and other uterine pathologies.