<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>
<bold>Objective:</bold> To assess the effect of removal of unsuspected polyps as delineated on saline sonography on the clinical pregnancy rate in women with unexplained infertility. <bold>Methodology:</bold> A prospective case control study was being conducted from 1st October 2016 to 30<sup>th</sup> September 2018 at Aziz Medical Centre, Karachi. Women diagnosed with unexplained infertility and unsuspected polyps revealed on saline sonography were included as cases (Group A). They were offered removal of polyps under ultrasound guidance and general anesthesia. Saline sonography was repeated at the time to ensure complete removal (Izhar’s Modification). Those with unsuspected polyps on saline sonography, but who refused the intervention, were classified as controls (Group B). Both groups were followed for one year. The primary outcome measure was women who had clinical pregnancy i.e. fetal heartbeat present on transvaginal scan during the follow up period. <bold>Results:</bold> During the study period, out of 92 cases, 37 (40.2%) conceived and out of 92 controls, 10 (10.9%) conceived, which proved that polypectomy increased the chances of conception four-fold (<italic>p</italic> &lt;0.001). The mean time to conception was also significantly lower for cases than controls (9.26 ± 3.928 months <italic>vs.</italic> 11.33 ± 2.07 months, <italic>p</italic> &lt;0.001). The cumulative pregnancy rate was significantly higher in the polypectomy group (log-rank test, <italic>p</italic> &lt;0.001). The duration of infertility (<italic>p</italic> = 0.007), position of polyp (<italic>p</italic> = 0.049) and polypectomy (<italic>p</italic> &lt;0.001) influenced pregnancy rate. <bold>Conclusions:</bold> Our study shows the beneficial effect of removal of polyps. Women are four times more likely to conceive spontaneously after polypectomy.</p>
</abstract>

Objective: To assess the effect of removal of unsuspected polyps as delineated on saline sonography on the clinical pregnancy rate in women with unexplained infertility. Methodology: A prospective case control study was being conducted from 1st October 2016 to 30th September 2018 at Aziz Medical Centre, Karachi. Women diagnosed with unexplained infertility and unsuspected polyps revealed on saline sonography were included as cases (Group A). They were offered removal of polyps under ultrasound guidance and general anesthesia. Saline sonography was repeated at the time to ensure complete removal (Izhar’s Modification). Those with unsuspected polyps on saline sonography, but who refused the intervention, were classified as controls (Group B). Both groups were followed for one year. The primary outcome measure was women who had clinical pregnancy i.e. fetal heartbeat present on transvaginal scan during the follow up period. Results: During the study period, out of 92 cases, 37 (40.2%) conceived and out of 92 controls, 10 (10.9%) conceived, which proved that polypectomy increased the chances of conception four-fold (p <0.001). The mean time to conception was also significantly lower for cases than controls (9.26 ± 3.928 months vs. 11.33 ± 2.07 months, p <0.001). The cumulative pregnancy rate was significantly higher in the polypectomy group (log-rank test, p <0.001). The duration of infertility (p = 0.007), position of polyp (p = 0.049) and polypectomy (p <0.001) influenced pregnancy rate. Conclusions: Our study shows the beneficial effect of removal of polyps. Women are four times more likely to conceive spontaneously after polypectomy.

Fertility outcome after saline sonography guided removal of intrauterine polyps in women with unexplained infertility

Journal of Ultrasonography

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Objective: To assess the effect of removal of unsuspected polyps as delineated on saline sonography on the clinical pregnancy rate in women with unexplained...

Characteristics	Hazards ratio (95% CI)	p value
Duration of infertility	1.244 (1.060; 1.460)	0.007*
Polypectomy	4.312 (2.112; 8.803)	<0.001*
Position of polyp		0.049*
Fundal	4.914 (0.665; 36.301)
Anterior	2.704 (0.331; 22.079)
Posterior	1.989 (0.249; 15.893)
Midcavity	Reference
Age	0.993 (0.907; 1.088)	0.884
Infertility type	1.260 (0.486; 3.271)	0.635
–2 log likelihood	469.299
Model chi square	34.853*
Degrees of freedom	7

Characteristic	Polyp removed n = 92 (%)	Not removed n = 92 (%)	p value
Age in years^†	30.13 ± 3.430	29.27 ± 2.685	0.060^‡
Duration of infertility in year^†	4.59 ± 2.001	4.32 ± 1.65	0.316^‡
Time to conception in months^†	9.26 ± 3.928	11.33 ± 2.07	<0.001^‡
Conception			<0.001*
Yes	37 (40.2%)	10 (10.9%)
No	55 (59.8%)	82 (89.1%)
Position of polyp			0.157*
Fundal	45 (48.9%)	38 (41.3%)
Anterior	16 (17.4%)	18 (19.6%)
Posterior	24 (26.1%)	34 (37.0%)
Midcavity	7 (7.6%)	2 (2.2%)
Type of infertility			0.282*
Primary	77 (83.7%)	82 (89.1%)
Secondary	15 (16.3%)	10 (10.9%)

Fertility outcome after saline sonography guided removal of intrauterine polyps in women with unexplained infertility

Article Category: original-paper

Published Online: Jun 28, 2019

Page range: 113 - 119

Received: Nov 03, 2018

Accepted: Mar 10, 2019

DOI: https://doi.org/10.15557/jou.2019.0016

Keywords
polyps, clinical pregnancy rate, unexplained infertility

© 2019 Rubina Izhar et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Fig. 2.

Factors affecting the clinical pregnancy rate

Comparison between cases and controls

Fertility outcome after saline sonography guided removal of intrauterine polyps in women with unexplained infertility

Article Category: original-paper

Published Online: Jun 28, 2019

Page range: 113 - 119

Received: Nov 03, 2018

Accepted: Mar 10, 2019

DOI: https://doi.org/10.15557/jou.2019.0016

Keywordspolyps, clinical pregnancy rate, unexplained infertility

© 2019 Rubina Izhar et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Fig. 2.

Factors affecting the clinical pregnancy rate

Comparison between cases and controls

Keywords
polyps, clinical pregnancy rate, unexplained infertility