Hysteroscopic polypectomy without cycle cancellation in IVF/ICSI cycles: a cross-sectional study.

Objective(s): To evaluate the effect of hysteroscopic polypectomy during ovarian stimulation phase on in vitro fertilization and/or intracytoplasmic sperm injection (IVF/ICSI) cycles outcomes.

Study Design: This cross sectional study was performed in female infertility department of Royan Institute from January 2011 to December 2013. In total, 160 patients who were diagnosed incidentally polyp/polyps less than 20mm during the stimulation phase for oocyte recoveries were recruited; of these, fifty eight cases underwent hysteroscopic polypectomy without cycle cancellation non-randomly. Polyp resection was performed through hysteroscopic polypectomy during ovarian stimulation. The interval between polypectomy and embryo transfer (ET) was 3-17 days. The women who did not undergo hysteroscopic polypectomy and matched for polyp size were selected as control group. The outcomes of IVF/ICSI cycles were compared between groups.

Results: The data analysis showed the two groups were comparable in terms of patients' characteristics and stimulation outcomes. The implantation rate was not significantly different between groups (P=0.3). The clinical pregnancy and live birth rates were similar between groups (%34.9 vs. %32.5 and %30.2 vs. %27.9, P=0.9 and P=0.8). No pregnancy was observed in patients who had the interval between hysteroscopic polypectomy until ET less than 5days and the multivariable logistic regression analysis revealed that the interval between polyp resection and ET was significant predictor for live birth rate (odds ratio: 1.2, confidence interval: 1.01-1.5, P=0.04).

Discussion(s): For the management of the polyps less than 20mm which have been diagnosed during the stimulation phase, the performance of hysteroscopic polypectomy without cycle cancellation does not improve the pregnancy and live birth rates. Therefore, it seems that the continuation of the treatment cycle and ignorance of these polyps is the appropriate treatment choice and the performance of hysteroscopic polypectomy and frozen embryo transfer program could be the next treatment option.