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Endometrial polyp and pregnancy: does a polyp stop implantation?

What is an endometrial polyp?

The endometrium is the lining inside the womb that thickens each month and is shed with the period. A polyp forms when a small patch of this lining grows more than the rest and pushes into the cavity, usually on a thin stalk or a broad base. Polyps are almost always benign. They can be single or several, and range from a few millimetres to a size that fills much of the cavity.

Polyps are linked to the hormone oestrogen, so they turn up more often in women with PCOS, endometriosis or a higher body weight, and in those taking certain hormone treatments. Some women notice spotting between periods, bleeding after intercourse or heavier periods. Many notice nothing at all, and the polyp is found only during fertility checks.

How is a polyp found in the womb?

Three tests are used, each adding detail to the last:

• Transvaginal ultrasound: the usual first look. A polyp can show as a bright, rounded area within the lining. It is seen most clearly in the first half of the cycle, soon after the period, when the lining is still thin.
• Saline scan (sonohysterography): a small amount of sterile salt water is passed gently through the cervix during the scan. The fluid opens up the cavity, so a polyp stands out against it and can be told apart from a thick lining or a fibroid.
• Hysteroscopy: a slim telescope passed through the cervix lets the doctor see the cavity directly. It confirms the polyp and can remove it in the same sitting.

A polyp is often picked up during routine fertility tests, or on the baseline scan at the start of a treatment cycle.

Can an endometrial polyp affect getting pregnant?

It can, though not every polyp matters. The evidence is mixed. A polyp may act a little like a foreign body in the cavity, causing mild inflammation and changing the signals the lining sends to an embryo. A larger polyp, or one near the openings of the tubes, may also get in the way of sperm reaching the egg.

Studies on removal before IUI suggest it may help some women conceive, while for very small polyps the benefit is less certain. Some small polyps shrink or disappear on their own over a few months. So the decision is made for each woman, looking at its size, its position, how many there are, her age and how long she has been trying.

Does a polyp matter before IVF or a frozen embryo transfer?

An embryo needs a calm, even lining to attach to. Because of this, many fertility teams prefer the cavity to be clear before an embryo is placed. If a polyp is seen during IVF stimulation, there are usually two choices. The embryos can be frozen and the polyp removed, with the frozen embryo transfer planned later. Or, if it is very small, the transfer may go ahead after discussion.

When transfers have already not worked, a fresh look at the cavity is part of the check-up described on our page on failed embryo transfer. A small polyp missed on a routine scan is one of the things a hysteroscopy can find.

When is removal usually advised?

Your doctor may recommend removing a polyp when:

• you are planning IUI, IVF or a frozen transfer and a polyp is confirmed;
• the polyp is larger, or there is more than one;
• it causes bleeding between periods or after intercourse;
• you have had embryo transfers that did not lead to a pregnancy;
• its look on the scan is unusual, so a sample is needed to check it under the microscope.

Removal is done by hysteroscopy as a short day procedure. The steps, the anaesthesia and the recovery are set out on our page on laparoscopy and hysteroscopy. As with any procedure inside the womb, there is a small risk of bleeding, infection or, rarely, injury to the womb wall, which is explained before you consent. The removed tissue is sent for testing as a routine step.

How soon can I try, or have a transfer, after polyp removal?

The lining usually heals quickly, because the polyp is taken off the surface without cutting deep into the womb. Many women are told they may try naturally from the next cycle, once any light spotting has stopped. For IUI, the next suitable cycle is often used.

For a frozen embryo transfer, a gap of one cycle is commonly planned so that the lining can rebuild fully, though your doctor may advise a different interval depending on what was removed. Your plan and dates are discussed with you before you leave.

What if a polyp is seen in early pregnancy?

Sometimes a polyp is noticed on an early pregnancy scan. In most cases it is left alone. A polyp can cause some spotting, but the pregnancy usually carries on normally, and a procedure inside the womb is generally avoided during pregnancy. Your doctor will keep an eye on things at your routine scans, and any polyp still present can be reviewed after delivery.

Bleeding in early pregnancy should always be checked, whatever the cause, so call the clinic the same day if it happens.

Where is a polyp checked and treated, and where can I consult?

Saline scans are done in Goa at the clinic, and hysteroscopy is done in Goa, in the practice's own operating theatre. You can start with a consultation at whichever of our clinics is nearest; the contact page lists them with their hours. Please bring earlier scan reports, any hysteroscopy notes and details of past treatment cycles. APPOINTMENTS ARE COMPULSORY FOR DOCTOR CONSULTATION.

Questions about endometrial polyps and pregnancy

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What you read here explains fertility care in general terms and cannot replace a consultation. Decisions about your own care should be made with a doctor who knows your history and has seen you. We do not carry out or offer sex determination of any kind, which is prohibited by law in India under the PCPNDT Act.