Optimal Time For Embryo Transfer After The Hysteroscopic Electrocision Of Polyp

Background:As hysteroscopy is widely applied in the assisted reproductive technology,endometrial polyps are easily found in the infertile patients. The pathogenesis of endometrial polyp is still undefined. There are several inferences:high expression of the estrogen receptor results in the endometrium hyperplasia,then endometrial polyps form;rate-limiting enzyme of the estrogen synthesis-aromatizing enzyme P450is abnormally highly synthesized,the local high concentration of P450may lead to the over synthesized estrogen,which can cause the local endometrium proliferation mediated by the related receptor;high expression of vascular endothelial growth factor (VEGF),transforming growth factor(TGF),insulin-like growth factor;abnormal expression of the apoptosis-related genes in the local endometrium,which causes the failure of endometrial apoptosis. The endometrial polyp can cause the abnormal uterine bleeding,the long-term chronic inflammation reaction,change of the embryo implantation microenvironment,interference of the sperm-egg meeting and the embryo implantation,which can lead to infertility. Hysterosalpinography, ultrasound, diagnostic dilatation and curettage, hysteroscopy can help find the polyps. Hysteroscopy and eye-directed biopsy are the golden standard for the diagnosis and hysteroscopic electrocision of polyps is believed to be the best method for the polyp patients,especially for the infertile couples who will accept in vitro fertilization and embryo transfer(IVF-ET),which can significantly improve the success rate of IVF-ET. Studies suggest that local inflammation induced by mechanical injuries could increase the endometrial receptivity.However,the hysteroscopic electrocision of polyps cause the electric injury, after the surgery whether the electric injury could make the same effect as the mechanical one and when is the optimal time for the embryo transfer is unsure, no related study has be done.Objective:Investigate the optimal time for the embryo transfer after the hysteroscopic electrocision of polyps to improve the success rate of IVF-ET.Method:A retrospective study was conducted on321infertile patients who had an endometrial polyp, as diagnosed by hysteroscopy.Polyps were treated with hysteroscopic electrocision. All samples were examined for pathology. The patients were subdivided into three groups. Group1:one month after the electrocision of polyps,embryo transfer was conducted.Group2:Two months after the electrocision of polyps,embryo transfer was conducted.Group3more than2months after the electrocision of polyps,embryo transfer was conducted.Pregnancy results were compared in the three groups.Result:Totally321cases of infertility women accepted the embryo transfer after the hysteroscopic electrocision of polyps. The pregnant results were followed-up among the cases after the hysteroscopic electrocision of polyps:Gl clinic pregnancy31cases (66%),biochemical Pregnancy4cases (2.1%),miscarriage5cases (10.6%),live birth24cases (51.1%);G2clinic pregnancy77cases(57.5%),biochemical Pregnancy4cases (3%),miscarriage8cases (6%),live birth68cases (50.7%);G3clinic pregnancy29cases (56.4%),biochemical pregnancy9cases (6.4%), miscarriage5cases (3.6%),live birth72cases (51.4%). There was no significant difference about the pregnant results.Conclusion:one months after the hysteroscopic electrocision of polyps,the cilinic doctor can choose anytime they need to conduct the embryo transfer for the infertile patients.