Does the time interval between hysteroscopic polypectomy and start of in vitro fertilization affect outcomes

Capsule:
Because waiting for at least two menstrual cycles after surgery does not necessarily yield superior outcomes, patients can undergo ovarian stimulation after their next menses following hysteroscopic polypectomy without affecting in vitro fertilization-embryo transfer outcomes.

Authors:
Nigel Pereira, M.D., Selma Amrane, M.D., Jaclyn L. Estes, B.S., Jovana P. Lekovich, M.D., Rony T. Elias, M.D., Pak H. Chung, M.D., Zev Rosenwaks, M.D.

Volume 105, Issue 2, Pages 539-544

Abstract:

Objective:
To investigate whether the time interval between hysteroscopic polypectomy and the start of IVF-ET cycles affect IVF cycle outcomes.

Design:
Retrospective cohort.

Setting:
Academic center.

Patient(s):
All patients diagnosed with endometrial polyps undergoing hysteroscopic polypectomy before fresh IVF-ET.

Intervention(s):
Hysteroscopic polypectomy.

Main Outcome Measure(s):
Patients were divided into three groups based on the time interval between hysteroscopic polypectomy and the start of a fresh IVF-ET cycle. Group 1 consisted of patients who underwent IVF-ET after their next menses, group 2 after two or three menstrual cycles, and group 3 after more than three menstrual cycles. Demographics, baseline IVF characteristics, controlled ovarian stimulation response, and pregnancy outcomes after ET were compared among the groups.

Result(s):
A total of 487 patients met inclusion criteria: 241 in group 1 (49.5%), 172 in group 2 (35.3%), and 74 in group 3 (15.2%). There were no differences in the baseline characteristics of the three groups. Ovarian stimulation outcomes, specifically total stimulation days, total gonadotropins administered, and number of oocytes retrieved, were similar between groups. There were no differences in the mean number of embryos transferred. The overall pregnancy outcomes were similar for groups 1, 2, and 3: implantation rate (42.4%, 41.2%, and 42.1%, respectively), clinical pregnancy rate (48.5%, 48.3%, and 48.6%), spontaneous miscarriage rate (4.56%, 4.65%, and 4.05%), and live birth rate (44.0, 43.6%, and 44.6%).

Conclusion(s):
Because waiting for two or more menstrual cycles after hysteroscopic polypectomy does not necessarily yield superior outcomes, patients can undergo ovarian stimulation after their next menses without affecting IVF-ET outcomes.

  • Daniel J. Kaser, MD

    Dear Dr. Pereira and colleagues,
    Thanks for your contribution, which quite succinctly demonstrates that a delay in cycle start beyond the first menstrual period following hysteroscopic polypectomy is not necessary. Do you have data available regarding the mean size of the resected polyp for each group? Also, what is the breakdown of cleavage vs. blastocyst transfer for each group?
    Thanks very much for your comments.

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