Fertility outcome after saline sonography guided removal of intrauterine polyps in women with unexplained infertility

Abstract

ObjectiveTo assess the effect of removal of unsuspected polyps as delineated on saline sonography on the clinical pregnancy rate in women with unexplained infertility.MethodologyA prospective case control study was being conducted from 1st October 2016 to 30th September 2018 at Aziz Medical Centre, Karachi. Women diagnosed with unexplained infertility and unsuspected polyps revealed on saline sonography were included as cases (Group A). They were offered removal of polyps under ultrasound guidance and general anesthesia. Saline sonography was repeated at the time to ensure complete removal (Izhar’s Modification). Those with unsuspected polyps on saline sonography, but who refused the intervention, were classified as controls (Group B). Both groups were followed for one year. The primary outcome measure was women who had clinical pregnancy i.e. fetal heartbeat present on transvaginal scan during the follow up period.ResultsDuring the study period, out of 92 cases, 37 (40.2%) conceived and out of 92 controls, 10 (10.9%) conceived, which proved that polypectomy increased the chances of conception four-fold (p <0.001). The mean time to conception was also significantly lower for cases than controls (9.26 ± 3.928 months vs. 11.33 ± 2.07 months, p <0.001). The cumulative pregnancy rate was significantly higher in the polypectomy group (log-rank test, p <0.001). The duration of infertility (p = 0.007), position of polyp (p = 0.049) and polypectomy (p <0.001) influenced pregnancy rate.ConclusionsOur study shows the beneficial effect of removal of polyps. Women are four times more likely to conceive spontaneously after polypectomy.

Mối tương quan giữa khoảng thời gian chờ từ phẫu thuật nội soi buồng tử cung cắt đốt polyp đến khi bắt đầu chuẩn bị nội mạc tử cung chuyển phôi trữ và tỷ lệ thai diễn tiến sau chuyển phôi trữ

“…Có nhiều phương tiện có thể dùng để chẩn đoán polyp NMTC bao gồm siêu âm ngả âm đạo 2D, 3D, chụp buồng tử cung -vòi trứng cản quang và siêu âm bơm nước buồng tử cung (saline infusion sonography -SIS) [8], nhưng tiêu chuẩn vàng trong chẩn đoán vẫn là nội soi buồng tử cung (NSBTC) [1]. Nhiều nghiên cứu trước đây cho thấy việc NSBTC cắt polyp giúp cải thiện tỷ lệ thai tự nhiên, tỷ lệ thai lâm sàng sau bơm tinh trùng vào buồng tử cung, hoặc trước khi thực hiện TTTON [9], [10], [11], [12]. Trong trường hợp TTTON, các nghiên cứu hiện tại cho thấy NSBTC cắt polyp ngay sau khi chọc hút trứng và chuyển phôi trữ sau đó không có sự khác biệt có ý nghĩa thống kê về tỷ lệ thai [5], [13], [14].…”

The freeze-all strategy after IVF: which indications?

“…Therefore, in case of late discovery of hydrosalpinges during the stimulation, a freeze all strategy is likely to provide the best chance for infertile women to obtain a live birth, as it allows surgical treatment between the COS and the ET. Similarly, in case of leiomyomas that distort the uterine cavity or in case of large endometrial polyps, a surgical resection before the ET can improve the live birth rate (Izhar et al, 2019;Saravelos et al, 2011).…”