Improving diagnosis and treatment for endometrial polyp

Background. The incidence of endometrial polyps has reached 25–35% making them the most common intrauterine pathology. Polyps account for every fourth hysteroscopy due to their association with abnormal uterine bleeding, infertility and malignancy risks. Absolute or relative hyperestrogenism are important factors in the development of endometrial polyp. Infectious and immune mechanisms have recently acquired special attention with the polyp pathogenesis.

Objectives. Management optimisation of infertile patients with endometrial polyp through differentiated choice of postoperative therapy.

Methods. We examined 90 patients of reproductive age (36.07 ± 6.14 years) with endometrial polyp and infertility conducting a comprehensive history analysis, assessment of reproductive function, extragenital and gynaecological pathology. Laboratory analyses comprised clinical and biochemical blood tests including vitamin and ferrum. Immunohistochemical endometrial estimators were CD16⁺, CD56⁺, HLA–DR(II)⁺.

Results. Patients with endometrial polyp and infertility had frequent bacterial vaginosis (90.0%), pelvic inflammations and vaginitises (78.89% each); endometrial polyp relapse was 10.4-fold more frequent in patients with infertility I compared to infertility II. Killer cell (CD16⁺ and CD56⁺) and HLA-DR(II)⁺ counts grow in chronic endometrial inflammation. Chronic autoimmune endometritis exacerbated in 53.33%, chronic exacerbated endometritis or acute endometritis were observed in 46.67%. Therapy differentiated by immunohistochemistry allowed successful pregnancy in natural cycles in 60.9% of patients with infertility I and in 85.7% — with infertility II.

Conclusion. The success rate of natural cycle pregnancy in patients of reproductive age with endometrial polyp after polypectomy is directly related to type of endometrial inflammation: chronic autoimmune, chronic exacerbated or acute endometritis. Immunohistochemical estimators can be used for differentiating therapy, which allowed a 70.3% pregnancy success rate.

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