Should You Remove a Polyp?

A number of publications have indicated that removing polyps is beneficial for getting pregnant, whether it's natural pregnancy rates, increase in the group that has polyps after you remove them, IUI, pregnancy rates increase in the group that has polyps after you remove them, and IVF. Specifically looking at IVF, studies have shown that there's no difference in when the polyp is removed. Meaning, if the polyp is there during the stimulation cycle and then removed prior to the transfer, there's no difference in pregnancy rates. So you can diagnose a polyp, go ahead and proceed with retrieving your eggs and making your embryos, and then take the polyp out before you do the transfer. That's my preference because I sometimes see that IVF and the estrogen production can potentially stimulate polyp growth.

There was a study that looked at IVF patients. It was small. There were less than 50 patients in each group, and it looked at polyps less than 1.5 centimeters in size. And this study was looking at seeing if taking that polyp out improved pregnancy or implantation rates. Notably, this was back in the time of a fresh transfer, so it is a little bit of an older study and not really how we practice now, but what they were looking at is do you take the polyp out before the stimulation? or do you leave it in place? This study suggested that if you had a polyp detected and taken out before your cycle, you had the same rate of pregnancy as patients with no polyps. It does propose that for polyps diagnosed during the IVF cycle, if you are planning a fresh transfer and the polyp was small, less than 1.4 centimeters in size, you didn't have to remove it. It didn't show a difference. Honestly, that doesn't only reflect current practices and because some of the natural pregnancy studies showed that the polyps might prevent pregnancy regardless of size or location. I think it's safest to remove a polyp. I believe in this study, they were trying to avoid canceling somebody's transfer back in the time period where we didn't have as good a freezing technology. Now that we do, I wouldn't feel comfortable proceeding with a transfer in the face of a polyp that I can see of any size. One time in my entire career have I had somebody who had a single polyp with no other risk factors for endometrial cancer, and it did come back cancerous. One patient is too many. If you find a polyp, personally, I want it out. I'm always looking for one before a transfer because you've gone through so much to get to this stage. So my final take home message is if you find a polyp, I would want it removed.