Saturday, September 23, 2006

About Uterine Polyps

A new buddy of mine online just posted that she was diagnosed with a polyp. Here's what I shared with her:

Fibroids and polyps can change the microenvironment in your uterus by irritating the lining and causing a reaction akin to what an IUD does I believe. You end up with your body reacting to the "foreign" object but at the same time it's so hyper active from an immune standpoint that it disallows implantation. (some of this is sort of subjective on my part but I've read a lot about implantation, fibroid, etc.)

Do you like your ob/gyn? Don't they have a backup? If you are really feeling put off then maybe try finding help elsewhere -- though here in Seattle getting in to see an ob/gyn as a new patient takes 2 months plus.

Here are some links for you:

Emerging endometrial polyp during controlled ovarian
stimulation affects IVF/ICSI outcome

Results: In the patients with endometrial polyps, no pregnancy was achieved. Clinical pregnancy rates and implantation rates of the second group were 28.35% (55/194) and 13.05%, respectively. Fifteen of the pregnant women (27.27%) experienced miscarriages. In some of the patients, hysteroscopy was performed for removal of the endometrial polyp. In part of them, after the polyp resection, spontaneous pregnancy occurred.
Conclusion: Our results reveal that endometrial polyp <10 mm, appearing during COS is a rare complication and it may have a negative influence on the IVF/ICSI outcome. In order to improve embryo implantation, we need to remove the above mentioned endometrial polyp. Abnormalities at the endometrial level and abnormal embryo–endometrial dialogue may be responsible for some cases of implantation failure. Endometrial polyp may be an impediment to embryo implantation because it acts as space occupying lesion and/or disturbs the expression of various endometrial products such as pinopodes, integrins and cytokines. It is not clear whether the expression of such factor as the endometrial polyp is the reason for implantation failure or is just a reflection of other abnormalities taking place in complex cascade of events.

From: ESHRE Meeting, June 2006 - Implantation

Surgery is usually recommended for polyps, for several reasons:
To try to improve fertility. Polyps may interfere with implantation of a fertilised egg in the lining of the womb, so they're often removed to try to improve the chances of conceiving.

From: Uterine Polyps

Leiomyomas and polyps are growing tumours and thus produce significant plasma glycodelin levels. Uterine glycodelin flushings are elevated in patients with both polyps and leiomyomas. Elevated glycodelin levels in the follicular and peri-ovulatory period may impair fertilization and implantation.
From: Glycodelin levels in uterine flushings and in plasma of patients with leiomyomas and polyps: implications for implantation.

Endometrial polyps appear to be organized overgrowths of the uterine endometrium, although the precise mechanisms leading to their development are not clearly defined. The endometrial lining of the uterine cavity grows in response to estrogen and is architecturally restructured in response to progesterone. If the response to estrogen is excessive, either in the presence of unopposed estrogen (such as during periods of anovulation) or whenever the bioactivity of the circulating estrogen is increased (such as with increased numbers of estrogen receptors or with decreased metabolism of estrogen) overgrowth of the endometrium may occur. If these overgrowths organize and develop their own blood supply then they become polyps.

The mere presence of polypoid overgrowths in the uterine cavity may (at least theoretically) interfere with implantation and fertility. I have envisioned polyps as acting sort of like IUDs in the cavity, creating a hostile environment for embryo implantation. I remove endometrial polyps in women with reproductive problems and these women (anecdotally) seem to do remarkably well in subsequent fertility efforts. A well designed research project describing fertility outcome after treatment for different types of endometrial polyps would be valuable.

Endometrial polyps are not always benign. I removed one normal appearing endometrial polyp hysteroscopically and this was found to contain an endometrial adenocarcinoma (cancer) on pathology report. Therefore, in the presence of any atypical overgrowth of tissue it is always important to think about the possibility of cancer

From: Miscarriages - Causes and Treatments

1 comment:

GoriGirl said...

Thanks for the post about polyps.. I am going in for surgical removal on wednesday and I am hoping it is the cause of our infertilty