Uterine Polyps in Ahmedabad

• The core problem: A polyp physically occupies space inside the uterine cavity — the space where the embryo must land and attach. When an embryo floats into the cavity after transfer, the polyp acts as a physical obstacle, preventing the embryo from making contact with healthy, receptive endometrium. This is functionally equivalent to the way a copper IUD prevents pregnancy — through physical interference with implantation.
• The size paradox: Even a 3–4mm polyp can prevent implantation if it sits at the fundus — the embryo’s preferred implantation site. Conversely, a 1cm polyp at the cervical end, away from the implantation zone, may have minimal impact. Location is the critical variable — not size.
• The evidence: A landmark 2001 study and subsequent meta-analyses consistently demonstrate that hysteroscopic polypectomy before IVF significantly improves pregnancy rates — with some studies showing a doubling of clinical pregnancy rates after polyp removal. The improvement is most pronounced for polyps within the uterine cavity (as opposed to cervical polyps).

• The inflammatory mechanism: A polyp is not an inert physical object. It is metabolically active tissue that generates a localised inflammatory microenvironment within the uterine cavity. Studies demonstrate elevated levels of pro-inflammatory cytokines in the endometrial fluid of women with polyps — including IL-6, TNF-α, and VEGF — disrupting the molecular receptivity signals the embryo depends on for attachment.
• Endometrial receptivity markers: Polyps alter the expression of key implantation receptivity markers — including HOXA10, αvβ3 integrin (implantation marker), and leukemia inhibitory factor (LIF). These are the same molecular receptors disrupted in adenomyosis — but in polyps, the disruption is localised to the area around the polyp, rather than global.
• After removal: Complete polypectomy resolves the localised inflammatory environment within one menstrual cycle. After one period post-removal, endometrial cytokine levels normalise and receptivity markers recover. This is why a single menstrual cycle recovery before the next IVF transfer is both standard and sufficient.

• The bleeding mechanism: Polyps cause abnormal uterine bleeding (AUB) through vascular fragility within the polyp’s surface vessels. Spotting between periods, heavy menstrual bleeding, and post-coital bleeding are the most common presentations.
• The fertility connection: In the context of IVF, mid-luteal or peri-implantation bleeding disrupts the hormonal environment at the critical implantation window — 5–9 days after ovulation or embryo transfer. Even minor bleeding during this window is associated with significantly reduced implantation rates in FET cycles.
• Silent polyps and failed cycles: Many women with polyps causing subtle intra-cavity bleeding never notice any symptoms — the bleeding is microscopic. But in an IVF cycle, this microscopic bleeding during the implantation window can be sufficient to prevent attachment. This is one reason polyps in otherwise ‘unexplained’ implantation failure cases are found on hysteroscopy after previous cycles showed ‘normal’ ultrasound scans.

At the first menstrual cycle after polypectomy, Dr. Shah performs a follow-up TVS to confirm complete removal and normal cavity restoration before proceeding to IVF stimulation. If multiple polyps were present or the base was broad, SIS may be repeated to confirm a clean cavity.

Day-care procedure at Wellspring IVF. Performed under short general anaesthesia (15–30 minutes total). No overnight hospital admission required. The patient arrives fasted in the morning and is discharged home the same afternoon.

A hysteroscope — a thin (3–5mm), rigid camera with a light source — is passed through the natural cervical opening into the uterine cavity. No cuts. No stitches. No abdominal incisions of any kind. The cervix is gently dilated if required (typically not necessary for a 3–5mm hysteroscope).

The uterine cavity is distended with sterile fluid (glycine or saline) to allow full visualisation. Dr. Shah systematically inspects the entire cavity — fundus, both cornua (tubal openings), anterior wall, posterior wall, and lower segment — before any resection. The polyp’s size, number, location, and attachment type (stalk vs broad base) are fully mapped.

A prior pregnancy with Down Syndrome (Trisomy 21), Edwards Syndrome, Patau Syndrome, or other chromosomal conditions indicates elevated risk. PGT-A substantially reduces recurrence probability.

Single polyp: typically 10–15 minutes operative time. Multiple polyps: 20–30 minutes. Total procedure time including anaesthesia induction: 30–45 minutes.

Mild period-like cramping for 24–48 hours. Light spotting for up to 1 week. Normal activity typically resumed within 1–2 days. No heavy lifting or intercourse for 2 weeks. Oral antibiotics prescribed for 5 days to prevent infection.

IVF stimulation can commence after one full menstrual cycle following polypectomy — typically 4–8 weeks. This waiting period allows: complete healing of the endometrium at the polypectomy site, restoration of normal endometrial architecture, and receipt + review of histology results.

Clinical pregnancy rates after hysteroscopic polypectomy and subsequent IVF are significantly higher than in untreated polyp patients. Multiple studies document a 50–100% improvement in implantation rates after complete polypectomy. The procedure consistently has one of the best cost-effectiveness ratios in reproductive medicine.