Endometrial polyps are localized overgrowths of the uterine lining. While usually benign, they act like a “natural copper-T” or contraceptive device inside the uterus. If you are struggling to conceive or facing repeated IVF failures, a small polyp might be the hidden cause.

Sonographic Appearance of Polyps

On a standard Transvaginal Ultrasound (TVS), a polyp appears as a well-defined, echogenic (bright) mass within the endometrial cavity. To confirm the diagnosis, we look for two specific markers:

• The Feeding Vessel (Pedicle Artery Sign): Using Color Doppler, we can often see a single artery supplying blood to the polyp. This distinguishes it from a fibroid, which usually has a circular blood supply.
• Intracavitary Fluid: Sometimes, natural fluid in the uterus helps outline the polyp, making it easier to see.

Saline Infusion Sonography (SIS)

When a standard scan is inconclusive, we perform an SIS (Water Scan). We gently infuse sterile saline into the uterine cavity during the ultrasound. The water “inflates” the cavity, allowing us to see exactly where the polyp is attached and how much space it is occupying.

Management: Hysteroscopic Polypectomy

At Talwar Fertility & Child Health Centre, we recommend removing polyps larger than 10mm or any polyp found in a patient with unexplained infertility. This is done via Hysteroscopy—a “no-cut” procedure where we use a tiny camera to enter the uterus and remove the polyp under direct vision. This significantly boosts natural and IVF pregnancy rates.

In our previous discussion, we identified the types of fibroids. However, the most common question patients at Talwar Fertility & Child Health Centre ask is: “Do I need to remove my fibroid before I can get pregnant?” The answer lies in precision mapping and understanding the FIGO classification of leiomyomas.

The Decision-Making Matrix

Using high-resolution Transvaginal Ultrasound, we evaluate whether a fibroid is a “silent bystander” or a “fertility blocker.” The clinical decision to treat depends on:

• The FIGO Grade: We grade fibroids from 0 to 7. Grades 0, 1, and 2 (Submucosal) almost always require removal as they occupy the space meant for the embryo.
• The 4cm Rule: Intramural fibroids (Grade 3 or 4) larger than 4-5 cm may reduce IVF success rates by altering blood flow to the endometrium.
• Vascular Mapping: Using Color Doppler, we check the ‘vascular rim’ of the fibroid. Highly vascular fibroids might grow rapidly during the high-estrogen phase of IVF stimulation.

Advanced Imaging: Beyond Basic Scans

For complex cases involving multiple fibroids, we often employ:

Treatment Options in Gurugram

If management is required, our approach is always minimally invasive to preserve uterine integrity:

• Hysteroscopic Myomectomy: For submucosal fibroids; no external incisions are made.
• Laparoscopic Myomectomy: For larger intramural or subserosal fibroids, ensuring a quick recovery.
• Medical Management: In some cases, we use hormonal down-regulation to shrink fibroids before starting an IVF cycle.