Endometrial polyps and infertility

Endometrial polyps are localized overgrowths of endometrial glands and stroma that project into the uterine cavity and are commonly identified in women of reproductive age. Although often asymptomatic, their potential contribution to infertility has become a focus of clinical and research interest. Proposed mechanisms linking polyps to reduced fertility include mechanical disruption of sperm transport or embryo implantation, distortion of the endometrial cavity and alterations in the molecular environment required for endometrial receptivity. Molecular evidence suggests that polyps may modify the expression of key implantation mediators such as HOXA10, glycodelin and leukaemia inhibitory factor, potentially creating a suboptimal environment for embryo implantation. This thesis provides a systematic review of current evidence on the relationship between EPs and reproductive outcomes in both natural and assisted conception. Using PRISMA methodology, the review gathers findings from observational studies and clinical trials, evaluating pregnancy outcomes before and after hysteroscopic polypectomy. Particular attention is given to the influence of polyp characteristics, including size, number, histological type and recurrence on fertility outcomes, as well as the role of polypectomy in women undergoing intrauterine insemination (IUI) and in vitro fertilization (IVF). The review also examines ongoing debates regarding the management of small or asymptomatic polyps prior to fertility treatment. By integrating clinical and molecular evidence, this thesis highlights the importance of individualized assessment and evidence-based management of EPs in the context of infertility. It further identifies limitations in the existing literature, including heterogeneity in diagnostic criteria and a lack of high-quality randomized trials, highlighting the need for future research to refine clinical guidelines and optimize reproductive outcomes for affected women.