Polyps and Fibroids

Common Fertility Problems
Key Points

  • Polyps and fibroids are tissue growths in the uterus.
  • Polyps and fibroids can affect fertility.
  • Removing polyps and fibroids can improve menstrual cycles and chances of pregnancy.

Polyps and fibroids

Polyps and fibroids are benign and often asymptomatic growths of the lining of the womb, affecting between 11% and 45% of women. The main difference between fibroids and polyps is the tissue they are made of. Whilst fibroids are made of a connective fibrous tissue, polyps made up of the same tissue that makes up the uterine lining, also known as endometrial tissue.

These growths can alter the micro-environment of the womb and interfere with sperm/egg movement, fertilisation and implantation. They are also the most commonly detected abnormality (16.7 %) in patients with recurrent implantation failures after IVF.

What are endometrial polyps?

Endometrial polyps are small, usually benign growths that occur in the endometrium (the inner lining of the uterus). They are attached to the endometrium and extend inward into the uterus. The size ranges between a few millimetres to a few centimetres. The reason why some polyps develop is not clear, but researchers believe it may be related to hormone levels.
You are more likely to have endometrial polyps if you are overweight, obese, have high blood pressure or are taking a medicine called tamoxifen.

What are endometrial fibroids?

Fibroids are growths, usually benign, of muscle cells in your uterus. They can grow in the muscle or protruding into the cavity of the uterus. When they are in the cavity (submucosal fibroids), they can cause symptoms such as heavy, painful periods and irregular bleeding. They can also cause reproductive problems, such as preventing you from becoming pregnant.

Symptoms of polyps and fibroids

You may have the following symptoms:

  • Irregular or unpredictable periods
  • Unusually heavy periods
  • Bleeding or spotting between periods
  • Infertility

Diagnosing polyps and fibroids

During routine investigations prior to treatment for infertility, an ultrasound scan will be able to identify if you have endometrial polyps or fibroids.

Your doctor will start by asking you about your menstrual cycles, how long they last, how heavy is the flow or any unusual symptoms you may be experiencing. The doctor may perform a transvaginal ultrasound, where a small device is inserted in the vagina to check for uterus abnormalities. The doctor may also suggest inserting sterile fluid into the uterus, which will allow for a clearer image of the uterus.

After the ultrasound, the doctor may suggest a hysteroscopy to help diagnose or treat polyps or fibroids. During this procedure, a small camera is inserted through the vagina into the uterus to give an image of the inside of your uterus. The doctor may do a biopsy of the uterus lining or remove the polyp or fibroid using special instruments.

Treating polyps and fibroids

If you don’t have any symptoms, you may not need to treat it. However, if you have heavy periods, bleeding in between periods, if the polyp/fibroid is affecting your ability to get pregnant or stay pregnant, it should be removed.

Your doctor may suggest some of these treatments:
  • Medications to help regulate the hormonal balance and help relieve symptoms.
  • Hysteroscopy in which a camera is inserted in the vagina through to the uterus and the polyp is removed using special instruments.

Impact on fertility

Up to 25% of women with unexplained infertility have endometrial polyps or fibroids diagnosed on hysteroscopy.

Researchers believe polyps and fibroids can cause infertility due to interference with sperm and embryo transport, embryo implantation, or altered endometrial receptivity. The size, number, or location of polyps/fibroids may also contribute to the outcome.

Several research studies reported that after having polyps or fibroids removed, more than 90% of women had their menstrual cycles normalised and spontaneous pregnancy increased to 61%.
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