Polyp Removal Before IVF — When to Proceed

Key Takeaways

• Uterine polyps can significantly reduce implantation rates, and removal is often recommended before IVF.
• The ideal timing for polyp removal is generally in the cycle before stimulation or transfer.
• Hysteroscopic removal is a safe, quick procedure that restores a healthy uterine cavity.
• Not all polyps require immediate removal—size, location, symptoms, and IVF history matter.
• Removing polyps often improves success rates, especially for women with prior failed cycles.

Uterine polyps are one of the most common findings during fertility evaluations. These small growths inside the uterine cavity may seem harmless, but even a tiny polyp can disrupt implantation at the crucial moment. For women preparing for IVF, donor cycles, or frozen embryo transfer (FET), determining when to remove a polyp—and whether it must be removed at all—is essential.

This blog explains the role of polyp removal in IVF planning, the ideal timing, and how it impacts success rates.

What Are Uterine Polyps?

Uterine polyps are benign overgrowths of the endometrial lining. They vary in size, may be single or multiple, and can distort the uterine cavity.

Why Polyps Matter for IVF

Polyps can interfere with:

• Implantation (blocking the embryo’s attachment site)
• Blood flow to the endometrium
• Local inflammation, affecting the embryo-endometrium dialogue
• Cycle timing, leading to delays or cancellations

Even small polyps have been associated with lower pregnancy rates in IVF.

When Should Polyps Be Removed Before IVF?

Most fertility specialists recommend removing polyps before IVF, especially if:

• The polyp is ≥1 cm
• It is located near the fundus or implantation zone
• You have had previous implantation failure
• Symptoms like irregular bleeding are present
• The polyp is discovered during FET preparation

Timing Guidelines

• Before stimulation: Ideal for fresh IVF cycles.
• Before FET: Mandatory, since the uterus must be perfectly optimized.
• After retrieval but before transfer: If discovered late, removal can be done between retrieval and transfer in a frozen cycle.

Do All Polyps Require Removal?

Not always.

Small, Sessile Polyps (<5 mm)

Small polyps may regress spontaneously and may not impact implantation.

Polyps in Women Under 35

Some clinics may proceed if the polyp is tiny and the cavity is otherwise normal.

When “Watch and Proceed” Is Reasonable

• If IVF timing is urgent
• If the polyp is very small
• If multiple ultrasounds confirm stability

Your doctor will weigh cycle timing, history, ultrasound findings, and risk factors.

Hysteroscopic Polyp Removal — What to Expect

Hysteroscopy is the gold-standard procedure for polyp removal.

Procedure Highlights

• Outpatient
• 10–20 minutes
• Minimal anesthesia
• No incisions
• Quick recovery (24–48 hours)

IVF Timeline After Removal

Most women can start IVF:

• In the next cycle after hysteroscopy, or
• 2–3 weeks later for FET preparation

How Polyp Removal Improves IVF Success

Research consistently shows that polyp removal improves:

• Implantation rates
• Clinical pregnancy rates
• Endometrial receptivity
• Cycle consistency and predictability

For women with repeated failures, hysteroscopy often reveals small polyps missed on ultrasound.

Case Study: A Missed Polyp That Changed an IVF Outcome

Patient: 37-year-old woman, two failed FETs with genetically normal embryos
Findings: Standard ultrasound showed nothing unusual.
Next Step: A saline infusion sonogram (SIS) detected a small fundal polyp.
Action: The polyp was removed hysteroscopically.
Outcome: Her next FET resulted in a successful pregnancy on the first attempt.

This case highlights how even tiny polyps, undetected on routine scans, can profoundly affect results.

Testimonials

1. Priya, 34

“I didn’t realize a small polyp was affecting our chances. After removal, my first embryo transfer worked. Smooth and painless experience!”

2. Ayesha, 39

“I had three failed cycles before a new clinic found a polyp. Fixing it changed everything. I wish we had done this earlier.”

3. Kavita & Rohit

“We were nervous about delaying our IVF cycle, but the doctor recommended removing a large polyp first. We’re so glad we listened.”

Expert Quote

“A healthy uterine cavity is the single most important factor for implantation. Removing polyps is one of the simplest yet most effective ways to improve IVF outcomes.”
— Dr. Rashmi Gulati

Related Links 

• Imaging Pathway — SIS, HSG, 3D Ultrasound, MRI
• Thin Lining — What Helps and What Doesn’t
• Cervical Factors — When Access Is the Issue
• Endometritis — Diagnosis and Treatment Basics

Glossary

Endometrial Polyp: Benign tissue growth in the uterine lining.
Hysteroscopy: Procedure to visualize and treat uterine cavity issues.
Implantation: Embryo attaching to the uterine lining.
FET (Frozen Embryo Transfer): Transfer of a previously frozen embryo.
Fundal Polyp: Polyp located at the top of the uterus.
Sessile Polyp: Small, flat polyp attached directly to the lining.
Cavity Distortion: When a structure interferes with the shape of the uterus.
Endometrial Receptivity: The period when the uterus can accept an embryo.
Stimulation Cycle: Phase of IVF where ovaries produce multiple eggs.
Cycle Cancellation: When a treatment plan is paused for safety or optimization.

FAQ

Q. Do all uterine polyps need to be removed before IVF?

Ans. No, but most clinically significant polyps (≥1 cm or cavity-distorting) should be removed. Small, stable polyps may be monitored depending on age, fertility history, and cycle urgency.

Q. Can I proceed with IVF stimulation if a polyp is discovered mid-cycle?

Ans. Yes, stimulation can continue. The embryo transfer can be postponed while the polyp is removed. Then a frozen embryo transfer (FET) can be planned later, preventing delays in egg retrieval.

Q. How do polyps affect implantation?

Ans. Polyps disrupt the uterine environment by creating inflammation, altering blood flow, and physically obstructing embryo attachment. They may also interfere with progesterone signaling important for implantation.

Q. What size of polyp requires removal?

Ans. Polyps larger than 1 cm should be removed. Even smaller ones may impact results if located at the fundus or near the implantation zone.

Q. How soon after hysteroscopic removal can I start IVF?

Ans. Most women begin IVF in the next menstrual cycle. For FET, preparation can begin 2–3 weeks post-procedure once healing is confirmed.

Q. Can a polyp grow back?

Ans. Yes, recurrence occurs in 5–15% of women. Regular monitoring through SIS or transvaginal ultrasound ensures timely management before embryo transfer.

Q. Is polyp removal painful?

Ans. Hysteroscopy is typically performed with light anesthesia or sedation. Most patients describe mild cramping afterward and resume normal activities within a day.

Q. Can polyps cause IVF failure?

Ans. Yes, studies show significant reductions in implantation and pregnancy rates when polyps are left untreated before IVF. Even small polyps may contribute to repeated failures.

Q. How are polyps detected if ultrasound looks normal?

Ans. Standard ultrasounds miss many small polyps. More detailed tests like SIS, 3D ultrasound, or hysteroscopy reveal subtler lesions.

Q. Can I get pregnant naturally with a polyp?

Ans. Yes, some women conceive naturally. But polyps increase miscarriage risk and reduce natural fertility in many cases.

Q. Are polyps cancerous?

Ans. Most uterine polyps are benign. Rarely, particularly in women over 45, polyps may show precancerous cells. Hysteroscopy allows safe removal and pathology evaluation.

Q. What if I’m already scheduled for embryo transfer and a polyp is found?

Ans. Most clinics postpone the transfer to remove the polyp first. This avoids wasted embryos and gives the best chance for success.