Common finding in patients with infertility and abnormal uterine bleeding

.Endometrial polyp
1-common finding in patients with infertility and abnormal uterine bleeding
2- diagnosis ( best time In the proliferative/follicular phase) by
a - 2 D ultrasound ( appears as a hyperechoic lesion )
b - if you add Doppler you will see single feeding vessel
c by 3D ultrasound
d- by 2d Saline infusion sonohysterography
e - by 3D SIS
f- hysteroscopy ( the gold standard )
3- blind dilatation and curettage or biopsy should not be used for diagnosis or treatment of endometrial polyp
4-treatment by hysterscopic polypectomy

Summary of the AAGL Practice Report: Practice Guidelines for the Diagnosis and Management of Endometrial Polyps 2012

Guidelines for Recognizing the Presence of Endometrial


  1. Increasing age is the most common risk factor for the

presentation of an endometrial polyp (Level B)

  1. For women with symptoms with a polyp, abnormal uterine bleeding is the most common presenting symptom (Level B).

  2. Infertile women are more likely to be diagnosed with an endometrial polyp (Level B).

  3. Polyps may naturally regress in up to 25% of patients,

with small polyps more likely to resolve spontaneously

(Level A).

  1. Medications such as tamoxifen may predispose to the

formation of endometrial polyps (Level B).

Guidelines for the Diagnosis of Endometrial Polyps

  1. TVUS provides reliable information for the detection of

endometrial polyps and should be the investigation of

choice where available (Level B).

  1. The addition of color or power Doppler increases the capacity of TVUS to diagnose endometrial polyps (Level B).

  2. Adding intrauterine contrast to sonography (with or without 3-D imaging) improves the diagnostic capacity for endometrial polyps (Level B).

  3. Blind dilation and curettage or biopsy should not be used for diagnosis of endometrial polyps (Level B).

Guidelines for the Management of Endometrial Polyps

  1. Conservative management is reasonable, particularly for small polyps and if asymptomatic (Level A).

  2. Medical management of polyps cannot be recommended at this time (Level B).

  3. Hysteroscopic polypectomy remains the gold standard for treatment (Level B).

  4. There does not appear to be differences in clinical outcomes with different hysteroscopic polypectomy techniques (Level C).

  5. Removal for histologic assessment is appropriate in postmenopausal women with symptoms (Level B).

  6. Hysteroscopic removal is to be preferred to hysterectomy because of its less-invasive nature, lower cost, and reduced risk to the patient (Level C).

For the infertile patient with a polyp, surgical removal is

recommended to allow natural conception or assisted reproductive technology a greater opportunity to be successful (Level A).