פוליפים והפלות

שלום דר', 1.האם פוליפ בחלל הרחם שלא הסירו אותו יכול לגרום להפלה? 2. לאורך השנים שאני עוברת טיפולים למיניהם, שמתי לב שאצל לא מעט בנות שסביבי שמצאו אצלן פוליפ בחלל הרחם, עברו הסטרוסקופיה ניתוחית ואח"כ הרו, עברו הפלה!! . האם זו תופעה מוכרת או ידועה?? 3. מה קורה אם יש השתרשות בדיוק באזור שעבר כריתה של פוליפ, או מעט לידו, האם העובר יכול להתפתח במקרה שכזה?? תודה.

תוך כדי טיפול ומעקב החודש גילו ב US חשד לפוליפ והחודש הוא הטיפול הראשון לאחר הפלה. בחששות כבדים להמשיך בטיפול, מצאתי שני מאמרים ב pub_med אחד טוען שיש עליה בסיכוי להפלות עם פוליפ והשני טוען את היפוכו של דבר. למי להאמין?????? אני מצרפת את המאמרים מאמר ראשון: J Assist Reprod Genet. 1999 Sep;16(8):410-5. Related Articles, Links The effect of endometrial polyps on outcomes of in vitro fertilization (IVF) cycles. Lass A, Williams G, Abusheikha N, Brinsden P. Bourn Hall Clinic, Cambridge, UK. PURPOSE: Our purpose was to investigate the effect of endometrial polyps on pregnancy outcome in an in vitro fertilization (IVF) program. METHODS: Endometrial polyps less than 2 cm in diameter were suspected by transvaginal ultrasound before oocyte recovery in 83 patients. Forty-nine women (Group I) had standard IVF-embryo transfer, while in 34 women (Group II) hysteroscopy AND polypectomy were performed immediately following oocyte retrieval, the suitable embryos were all frozen, AND the replacement cycle took place a few months later. RESULTS: Of the 32 hysteroscopies, a polyp was diagnosed in 24 cases (75%) AND polypoid endometrium in another 5 patients (15.6%). An endometrial polyp was confirmed by histopathological examination in 14 women (58.3%). The pregnancy rate in group I was similar to the general pregnancy rate of our unit over the same period (22.4 vs 23.4%) but the miscarriage rate was higher (27.3 vs 10.7%, P = 0.08). In Group II, the pregnancy AND miscarriage rates were similar to those of the frozen embryo cycles at Bourn Hall (30.4 AND 14.3 vs 22.3 AND 12.1%, respectively). CONCLUSIONS: Small endometrial polyps, less than 2 cm, do not decrease the pregnancy rate, but there is a trend toward increased pregnancy loss. A policy of oocyte retrieval, polypectomy, freezing the embryos, AND replacing them in the future might increase the "take-home baby" rate. מאמר שני: J Am Assoc Gynecol Laparosc. 1996 Aug;3(4, Supplement):S29. Related Articles, Links Fertility Outcome after Outpatient Hysteroscopic Removal of Endometrial Polyps AND Submucous Fibroids Mastrominas M, Pistofidis GA, Dimitropoulos K. Embryogenesis Fertility Centre, Eleftherias 16 & Parnithos, Nea Filothei, Athens 151 23, Greece. We assessed the value of hysteroscopic removal of polyps AND submucous fibroids from women requesting fertility treatment. Between December 1991 AND June 1995 we recruited 146 women (age 28-44 yrs) with such lesions who were undergoing investigations for in vitro fertilization (IVF). In most of them, intrauterine pathology was not the sole cause of subfertility. In all women the lesions were diagnosed by hysterosalpingography OR vaginal ultrasound examination with fluid instillation AND subsequent hysteroscopy. In 122 patients the lesion was removed hysteroscopically with the resectoscope under light sedation in an outpatient setting. No complications occurred during OR after surgery. The remaining 24 patients with polyps smaller than 2 cm underwent IVF treatment directly. In the 122 women who proceeded to treatment, further diagnostic office hysteroscopy was also performed. Group A consisted of 82 women with up to three polyps (65 <2 cm, 17 >2 cm); group B, 40 women with up to five fibroids smaller than 4 cm; AND group C, 24 women with ultrasound diagnosis of polyps smaller than 2 cm for whom no treatment was carried out. In groups A AND B the diagnosis was confirmed histologically. All these women subsequently underwent IVF. In group A (<2 cm polyps) the pregnancy rate was 28% per embryo transfer, AND in the rest of group A (>2 cm) it was 40%. In group B the pregnancy rate was 46% AND in group C 35%. We think that polyps less than 2 cm diameter do not require removal before IVF AND do not affect the outcome of the subsequent pregnancy. תודה שוב.