Written by Shahin Ghadir, MD (Southern California Reproductive Center)
Fertility specialists often find that pelvic abnormalities are present in women who have difficulty conceiving. These abnormalities may include hydrosalpinx, which is a swelling (distention) of the fallopian tube, or a variety of pelvic growths - a category which includes polyps. Polyps are a frequent cause of infertility.
Polyps are masses, or growths, of tissue. They may occur in various body tissues, and you probably have heard of nasal polyps, vocal cord polyps, and colon polyps. The polyps that fertility specialists are concerned with occur in the reproductive tract, particularly in the uterus and cervix. Masses that occur on the ovaries are called cysts, not polyps.
The uterus is actually comprised of two main sections: the uterine corpus (body of the uterus) and the cervix (the neck of the uterus; it connects to the vagina). The endometrium is the lining of the uterine corpus. So when we talk about uterine polyps, this term mainly refers to endometrial polyps as opposed to cervical polyps. Polyps are often described based on their physical appearance, and any polyp, regardless of its location, may be described either as sessile (flat) or pedunculated (having a “foot” or “stalk” attached to it).
Endometrial polyps are growths that develop in the endometrium (uterine lining). The majority of endometrial polyps are benign (non-cancerous). Symptoms of endometrial polyps include heavy or irregular menstrual bleeding and bleeding between menstrual periods. However, many women with endometrial polyps experience no obvious symptoms at all. For some, the only symptom is infertility! The exact cause of endometrial polyps is unknown, but we do know that the polyps grow in response to estrogen.
As fertility specialists, we know that approximately 16-26% of women with otherwise-unexplained infertility are found to have endometrial polyps on diagnosis. How do endometrial polyps affect fertility? The answer may be related to mechanical interference with sperm transport, inhibition of embryo implantation, or the production of chemicals that inhibit normal pregnancy, but regardless of the exact mechanism, it is clear that endometrial polyps significantly decrease fertility.
There are several methods commonly used by fertility specialists in the diagnosis of endometrial polyps. These include:
In terms of sheer diagnostic accuracy, hysteroscopy is considered the gold standard for diagnosis of endometrial polyps because it allows for direct visualization of the area as well as for surgical treatment to be carried out at the same time. This “see-and-treat” approach blurs the distinction between diagnostic and surgical procedures. The procedure is entirely outpatient and minimally invasive, typically using only conscious sedation and local anesthesia. At SCRC, we perform the procedure in our on-site outpatient surgery center. During hysteroscopy, the surgical instruments required to remove the polyps are passed through the hysteroscope. An instrument called the “Twizzle electrode” cuts through and simultaneously vaporizes the tissue.
Cervical polyps are small, finger-like growths in the cervix that can sometimes project into the vagina. As with endometrial polyps, many women who have cervical polyps have no symptoms except for infertility. When symptoms are present, they tend to include abnormal vaginal bleeding, which may occur after douching or sexual intercourse, and bleeding in between menstrual periods. The causes of cervical polyps include chronic inflammation, infection, and increased estrogen levels.
Diagnosis of cervical polyps is usually accomplished by a thorough pelvic exam. The treatment of cervical polyps is fairly straightforward. Most polyps can be removed in our office during the pelvic exam using a special type of forceps.
You should know that cervical polyps are not the same as cervical cancer. In fact, about 99% of cervical polyps are benign. After the polyp is removed, it is sent to the lab for biopsy to make sure there are no cancerous or precancerous cells.
Call SCRC at (800) 600-9112 to speak to one of our helpful fertility consultants. They will be glad to give you more detailed information about diagnosis and treatment of polyps as well as information about surgical infertility treatment in general. They can also schedule a consultation for you with an SCRC fertility specialist. If you prefer, you may also click here to contact us.