Today we want to present a case of a patient who came to Creafam Veracruz for primary infertility. As part of her evaluations prior to carrying out IVF fertility treatment, we performed a vaginal pelvic ultrasound where we had the opportunity to observe signs of endometrial pathology.

Evaluations prior to in vitro treatment are very important since there may be other associated pathologies that the patient is unaware of and that may eventually affect the prognosis of the result.

In this case, our patient was a 39-year-old patient, with more than five years of primary infertility. She had some very brief basic studies, very normal, and then we started the study plan; We indicate a semen study, hormonal tests, blood tests and as part of this, we perform a pelvic ultrasound vaginally. When an ultrasound is performed, the interpretation of the images will depend a lot on the moment of the cycle in which the patient is, particularly ultrasounds from the first half of the cycle, that is, before ovulation, can provide us with a lot of information about the endometrium. As you will see below, this patient presented a finding that was important to resolve since it could affect the prognosis of the future treatment that we are going to perform, which in her case will be in vitro fertilization. Once the diagnosis of endometrial polyps has been made by ultrasound, it is important to offer the patient alternatives.

There are doctors who propose performing uterine curettage and with that they can extract it, in our opinion in a very bloody attitude for the endometrium, especially in patients who want fertility, since we can cause damage to the cavity that worsens the prognosis. The best alternative to remove endometrial polyps is through hysteroscopy, an endoscopic procedure specifically designed to attend to the uterine cavity and that allows us to observe all the characteristics of the cervix, the cavity, the origin of the tubal ostia and a very precise evaluation. of the endometrium and the space that the patient has in her uterine cavity.

When we perform hysteroscopy, we first distend the uterine cavity with a liquid medium. This allows the walls of the uterus to expand and the endoscope can pass through and observe what we are going to do. You can see how the polyp is freely implanted in the bottom of the uterus, that is what is called a sessile polyp. It has a small base and is free in the cavity, then the instruments with which we are going to remove it are passed through the same endoscope. In this case, with scissors we are going to cut the base of the polyp and then with a small forceps we can extract it, sometimes when the polyps are larger we can also use some electrosurgical instruments that allow us to cut and coagulate at the same time and that way, then treat the injury.

When they are larger polyps we can even only resect the base and leave them there because it can be very difficult to extract them to the outside, but hey, the important thing is to solve the problem. The base is sectioned, the polyp is left and later when the tissue degenerates, it is expelled. As it is a procedure that is performed completely on an outpatient basis and we are attacking a very, very specific lesion, the next step is simply to wait for the menstrual cycle to end, the rest of the endometrium is peeled off and once the new cycle begins we can go directly to carry out the fertility treatment, that is, there is no need to wait for breaks of two, three or four months since we are attending to a very specific moment in the cycle.

This image corresponds to the same patient that we performed hysteroscopic surgery for polyp. This corresponds to the uterine muscle and here in the center, the cavity. We see a very well developed endometrium and obviously it no longer has the image of the polyp, so it can now be prepared for pregnancy. It is very common for patients to come and tell us “No, I already have all the studies”… And when we see, well, they are simply very general studies: Blood count, blood chemistry, perhaps a pap smear.

To make a good diagnosis in fertility we need a good transvaginal pelvic ultrasound, you need a good spermiogram with reliable results, in other cases hysterosalpinography to evaluate the tubes well, that is, you need to have a comprehensive evaluation of the different factors that can affect fertility. fertility.

In the case of vaginal pelvic ultrasound we are aimed at evaluating ovaries and evaluating the uterus, and the uterus includes the endometrium, where we can detect pathologies such as endometrial polyps. There are women who have endometrial polyps but are not seeking fertility, sometimes there is constant bleeding after of the period or before the period, then endometrial polyps can occur and cause bleeding that gynecologically affects the life of the patients. The best solution in these cases is to perform a hysteroscopy, which is a quick, simple, completely outpatient procedure for such specific problems. Come to Creafam.

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