Key Facts
- Endometrial polyps, also called uterine polyps, are found in roughly 15% to 24% of women evaluated for infertility.
- Two randomized controlled trials found that removing a polyp before intrauterine insemination (IUI) roughly doubled cumulative pregnancy rates over four cycles.
- A 2018 Cochrane review agreed removal likely helps before IUI, but rated the evidence quality as low and called for larger trials.
- For IVF specifically, there are no completed randomized trials yet. The evidence is observational, but it consistently favors removal before embryo transfer.
- Hysteroscopy is both the gold standard diagnostic test and the treatment; the procedure that confirms a polyp is present can often remove it in the same visit.
- At Kim Gyn, in-office diagnostic hysteroscopy and outpatient hysteroscopic polypectomy are both available under Dr. Kim’s direct care, with pathology sent on every specimen removed.
If you were told you have a polyp while trying to conceive, the short answer is this: it is a common, treatable finding, and removing it before fertility treatment is linked to meaningfully better odds of pregnancy, especially ahead of IUI.
What Is an Endometrial Polyp?
An endometrial polyp is a localized overgrowth of uterine lining tissue that projects into the uterine cavity. Endometrial polyps and uterine polyps are the same condition; the terms are interchangeable. Polyps come up often during fertility workups because the uterine cavity is exactly the space an embryo needs to implant in, and even a small polyp occupies space that could otherwise support that process.
How Common Are Endometrial Polyps in Women Being Treated for Infertility?
Endometrial polyps are identified in an estimated 15% to 24% of women undergoing evaluation for infertility, based on hysteroscopy series (Elmoghazy, 2007). Prevalence rises further in women who also have abnormal uterine bleeding, which is one reason the American Society for Reproductive Medicine (ASRM) recommends uterine cavity imaging as a standard part of the female infertility workup (ASRM, 2021).
Women with endometriosis appear to be at higher risk still: one hysteroscopy-based study found polyps in 68% of infertile women with confirmed endometriosis, versus 21% of those without it. If you have both conditions, a cavity evaluation is worth discussing even before a polyp shows on ultrasound.
How Do Endometrial Polyps Actually Interfere With Fertility?
- Mechanical crowding. A polyp occupies cavity space that could otherwise be a receptive implantation site.
- Disrupted local lining. Polyps alter the endometrium immediately around them, which may interfere with the signaling an embryo relies on to implant.
- [NEW CLAIM, NEEDS DR. KIM REVIEW] A localized inflammatory state. A 2024 cross-sectional study found infertile women with polyps had roughly five times higher odds of also having chronic endometritis, a low-grade uterine inflammation independently linked to implantation failure (OR 5.2, 95% CI 2.9-9.2).
None of these require a polyp to be large or symptomatic. Small, incidental polyps are still worth addressing before treatment begins.
Does Removing a Polyp Improve Your Chances of Getting Pregnant?
This is the question with the most direct evidence behind it, at least for IUI. Two randomized controlled trials tested this directly, each assigning patients to either polypectomy or no removal before up to four IUI cycles.
| Study | Design | Comparison | Result |
|---|---|---|---|
| Pérez-Medina et al., 2005 (Human Reproduction) | RCT, n=215 | Polypectomy vs. diagnostic hysteroscopy only | Relative risk 2.1 (95% CI 1.5-2.9) for pregnancy in the polypectomy group |
| Shohayeb & Shaltout, 2011 (Middle East Fertility Society Journal) | RCT, n=120 | Polypectomy vs. no intervention | Cumulative pregnancy rate 38.3% vs. 18.3%, p=0.015 |
A 2017 systematic review combined both trials and calculated an average cumulative pregnancy rate of 55.3% after polypectomy versus 25.2% without it, over four IUI cycles, and found polypectomy cost-effective compared with proceeding to IUI without removal (systematic review, 2017).
For balance: a 2018 Cochrane review reached a more cautious conclusion, agreeing polypectomy likely helps before IUI while rating the evidence quality as low, since only two trials met its criteria (Cochrane, 2018). That does not undercut the direction of the results; the exact size of the benefit is still being refined.
What About Before IVF?
No randomized trial has yet tested polypectomy specifically before IVF. What exists instead is observational and retrospective data, which consistently favors removing a polyp before embryo transfer, without the same statistical certainty an RCT provides.
ASRM’s most recent guidance on recurrent pregnancy loss reflects that same balance: it notes limited data showing an increase in live birth after polypectomy, and concludes it is reasonable to offer removal to women with recurrent pregnancy loss who have a polyp (ASRM, 2026). In practice, this is why most fertility specialists recommend clearing the cavity of polyps before starting an IVF cycle, even without a completed RCT to point to.
How Are Endometrial Polyps Diagnosed During a Fertility Workup?
- Transvaginal ultrasound is usually the first step and may show a thickened or irregular area of endometrium.
- Sonohysterography (a saline-infused ultrasound) outlines the cavity more clearly when a polyp is suspected but not clearly seen.
- Hysteroscopy is the gold standard: a thin camera visualizes the cavity directly, confirms the polyp, and can remove it in the same visit.
One caveat: hysterosalpingography (HSG), the dye-and-X-ray tubal patency test many patients have, is not reliable for polyps alone. ASRM puts its sensitivity for polyps in asymptomatic infertile women at only around 50%, with a positive predictive value of about 30% (ASRM, 2021). A clear HSG does not rule out a polyp.
What Happens During Hysteroscopic Polypectomy?
Hysteroscopic polypectomy is performed under direct visualization, using small instruments passed through the hysteroscope to remove the polyp at its base.
- No external incisions are made
- The procedure typically takes 15 to 30 minutes
- It can often be performed in-office, in the same visit as the diagnostic hysteroscopy
- Removed tissue is sent for pathologic analysis as standard practice
- Most patients resume normal activity within one to two days
Key takeaway: if you are planning IUI or IVF and a polyp has been identified, or your uterine cavity has not yet been evaluated, addressing it beforehand is a low-risk step with real evidence behind it, particularly ahead of IUI. The relevant question is not whether polyps can matter, but whether one is present in your case.
Take the Next Step with Dr. Kim
If a polyp has been identified on your ultrasound, or your uterine cavity has not yet been evaluated as part of your fertility workup, Dr. Kim offers in-office diagnostic hysteroscopy and same-visit hysteroscopic polypectomy on the Upper East Side. Schedule a consultation to get a clear answer before your next cycle.
Frequently Asked Questions About Uterine Polyps and Fertility
Can a small, symptom-free polyp still affect fertility?
Yes. The trials above did not restrict enrollment to large or symptomatic polyps, which is why removal is generally recommended before fertility treatment regardless of symptoms.
How soon after polypectomy can I start IUI or IVF?
In the trials on this topic, patients typically proceeded to IUI within one to a few menstrual cycles after polypectomy. Timing should be individualized with your physician based on healing and your specific protocol.
Do all polyps need to be removed before fertility treatment?
Most fertility specialists recommend removing any identified polyp before IUI or IVF, given the consistent direction of the evidence and the low risk of the procedure itself. Your physician will weigh polyp size, location, and timing.
Can a polyp come back after it is removed?
Yes. Studies report recurrence rates of roughly 15% to 20% over several years, which is why continued monitoring matters even after a successful polypectomy.