{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:30:06Z","timestamp":1792189806525,"version":"4.4.0"},"reference-count":34,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T00:00:00Z","timestamp":1723507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: To assess the effect of hysteroscopic polypectomy on the in vitro fertilization (IVF) results in infertile women with at least one prior negative IVF outcome. Methods: This retrospective cohort study included women who had attended the \u201c2nd Department of Obstetrics and Gynecology of the National and Kapodistrian University of Athens\u201d and \u201cIaso\u201d Maternity Hospital from October 2019 to January 2023 for infertility treatment. The medical records of 345 women aged 18\u201345 years old without abnormal findings in hysterosalpingography (HSG) and with at least one previous failed IVF procedure were analyzed. The male factor was excluded, as well as a prior hysteroscopic removal of polyps. In 67 women, polyps were suspected during initial two-dimensional ultrasound (2D-US) examination. The final sample of the study comprised 40 patients, in which endometrial polyps were removed by hysteroscopy with the use of resectoscope. All patients underwent ovarian stimulation and IVF in the consecutive cycle using a short GnRh antagonist protocol. Main Results: After hysteroscopic polypectomy, 29 (72.5%) out of 40 patients had a positive pregnancy result: 26 (65%) clinical and 3 (7.5%) biochemical pregnancies were documented. There was a statistically significant difference between the number of clinical pregnancies before and after polypectomy (p &lt; 0.001), as well as between the total number of pregnancies (p &lt; 0.001). Secondary Results: Women with positive outcome were significantly younger and had significantly lower FSH levels (p &lt; 0.007). They also had significantly higher AMH (p &lt; 0.009) and peak estradiol levels (p &lt; 0.013) and yielded more M II oocytes (p &lt; 0.009) and embryos (p &lt; 0.002). Conclusions: Hysteroscopic polypectomy in women with a suspected endometrial polyp using 2D ultrasound and a history of prior failed IVF attempt improves IVF outcomes in terms of the clinical and total number of pregnancies.<\/jats:p>","DOI":"10.3390\/jcm13164755","type":"journal-article","created":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T10:54:54Z","timestamp":1723546494000},"page":"4755","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Impact of Hysteroscopic Polypectomy on IVF Outcomes in Women with Unexplained Infertility"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4403-0511","authenticated-orcid":false,"given":"Olga","family":"Triantafyllidou","sequence":"first","affiliation":[{"name":"2nd Department of Obstetrics and Gynaecology, Aretaieio Hospital, National and Kapodistrian University of Athens, Vas. Sofias Str. 76, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilias","family":"Korompokis","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetrics and Gynaecology, Aretaieio Hospital, National and Kapodistrian University of Athens, Vas. Sofias Str. 76, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stamatia","family":"Chasiakou","sequence":"additional","affiliation":[{"name":"Hippocratio General Hospital of Athens, Greece V. Sofias 114, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Bakas","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetrics and Gynaecology, Aretaieio Hospital, National and Kapodistrian University of Athens, Vas. Sofias Str. 76, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1379-894X","authenticated-orcid":false,"given":"Theodoros","family":"Kalampokas","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetrics and Gynaecology, Aretaieio Hospital, National and Kapodistrian University of Athens, Vas. Sofias Str. 76, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1000-9100","authenticated-orcid":false,"given":"Mara","family":"Simopoulou","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetrics and Gynaecology, Aretaieio Hospital, National and Kapodistrian University of Athens, Vas. Sofias Str. 76, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9237-3426","authenticated-orcid":false,"given":"Despoina","family":"Tzanakaki","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetrics and Gynaecology, Aretaieio Hospital, National and Kapodistrian University of Athens, Vas. Sofias Str. 76, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1444-6161","authenticated-orcid":false,"given":"Emmanouil","family":"Kalampokas","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetrics and Gynaecology, Aretaieio Hospital, National and Kapodistrian University of Athens, Vas. Sofias Str. 76, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelia","family":"Panagodimou","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetrics and Gynaecology, Aretaieio Hospital, National and Kapodistrian University of Athens, Vas. Sofias Str. 76, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Xepapadaki","sequence":"additional","affiliation":[{"name":"Department of Microbiology, General Hospital of Attica \u201cKAT\u201d, \u039dikis Str. 2, 14561 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4112-8396","authenticated-orcid":false,"given":"Panagiotis","family":"Christopoulos","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetrics and Gynaecology, Aretaieio Hospital, National and Kapodistrian University of Athens, Vas. Sofias Str. 76, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Valsamakis","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetrics and Gynaecology, Aretaieio Hospital, National and Kapodistrian University of Athens, Vas. Sofias Str. 76, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8479-6517","authenticated-orcid":false,"given":"Nikolaos F","family":"Vlahos","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetrics and Gynaecology, Aretaieio Hospital, National and Kapodistrian University of Athens, Vas. Sofias Str. 76, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.beem.2018.09.003","article-title":"The Endometrium during and after Ovarian Hyperstimulation and the Role of Segmentation of Infertility Treatment","volume":"33","author":"Polyzos","year":"2019","journal-title":"Best. Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Artimovi\u010d, P., Badovsk\u00e1, Z., Toporcerov\u00e1, S., \u0160pakov\u00e1, I., Smolko, L., Sabolov\u00e1, G., Kriv\u00e1kov\u00e1, E., and Rabajdov\u00e1, M. (2024). Oxidative Stress and the Nrf2\/PPAR\u03b3 Axis in the Endometrium: Insights into Female Fertility. Cells, 13.","DOI":"10.3390\/cells13131081"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Vitagliano, A., Cialdella, M., Cicinelli, R., Santarsiero, C.M., Greco, P., Buzzaccarini, G., Noventa, M., and Cicinelli, E. (2021). Association between Endometrial Polyps and Chronic Endometritis: Is It Time for a Paradigm Shift in the Pathophysiology of Endometrial Polyps in Pre-Menopausal Women? Results of a Systematic Review and Meta-Analysis. Diagnostics, 11.","DOI":"10.3390\/diagnostics11122182"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2690","DOI":"10.1016\/j.fertnstert.2010.12.034","article-title":"Endometrial Polyps Affect Uterine Receptivity","volume":"95","author":"Rackow","year":"2011","journal-title":"Fertil. Steril."},{"key":"ref_5","first-page":"1","article-title":"A Randomised Controlled Trial of Outpatient versus Inpatient Polyp Treatment (OPT) for Abnormal Uterine Bleeding","volume":"19","author":"Clark","year":"2015","journal-title":"Health Technol. Assess."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.fertnstert.2007.09.069","article-title":"The Uterus and Fertility","volume":"89","author":"Taylor","year":"2008","journal-title":"Fertil. Steril."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.fertnstert.2007.05.072","article-title":"Location of Endometrial Polyp and Pregnancy Rate in Infertility Patients","volume":"90","author":"Yanaihara","year":"2008","journal-title":"Fertil. Steril."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2742","DOI":"10.1093\/humrep\/17.10.2742","article-title":"Glycodelin Levels in Uterine Flushings and in Plasma of Patients with Leiomyomas and Polyps: Implications for Implantation","volume":"17","author":"Richlin","year":"2002","journal-title":"Hum. Reprod."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"102350","DOI":"10.1016\/j.jogoh.2022.102350","article-title":"The Role of Hysteroscopy in Reproductive Surgery: Today and Tomorrow","volume":"51","author":"Riemma","year":"2022","journal-title":"J. Gynecol. Obstet. Hum. Reprod."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"198","DOI":"10.5653\/cerm.2020.04119","article-title":"Management of Endometrial Polyps in Infertile Women: A Mini-Review","volume":"48","author":"Jee","year":"2021","journal-title":"Clin. Exp. Reprod. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.ejogrb.2021.03.017","article-title":"From the Global Community of Hysteroscopy Guidelines Committee. Endometrial Polyps. An Evidence-Based Diagnosis and Management Guide","volume":"260","author":"Vitale","year":"2021","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"100178","DOI":"10.1016\/j.xagr.2023.100178","article-title":"Effect of the Decision to Perform Hysteroscopy on Asymptomatic Patients before Undergoing Assisted Reproduction Technologies-a Systematic Review and Meta-Analysis","volume":"3","author":"Marchand","year":"2023","journal-title":"AJOG Glob. Rep."},{"key":"ref_13","first-page":"CD012856","article-title":"Screening Hysteroscopy in Subfertile Women and Women Undergoing Assisted Reproduction","volume":"4","author":"Kamath","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_14","first-page":"CD009461","article-title":"Hysteroscopy for Treating Subfertility Associated with Suspected Major Uterine Cavity Abnormalities","volume":"1","author":"Bosteels","year":"2013","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1136\/jclinpath-2018-205579","article-title":"Investigation and management of subfertility","volume":"72","author":"Thurston","year":"2019","journal-title":"J. Clin. Pathol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1016\/j.jfma.2018.08.017","article-title":"Factors Increasing the Detection Rate of Intrauterine Lesions on Hysteroscopy in Infertile Women with Sonographically Normal Uterine Cavities","volume":"118","author":"Yang","year":"2019","journal-title":"J. Formos. Med. Assoc. Taiwan Yi Zhi"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.jmig.2013.07.023","article-title":"Role of Hysteroscopy Prior to Assisted Reproduction Techniques","volume":"21","author":"Bakas","year":"2014","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s00404-013-2931-8","article-title":"Role of Hysteroscopy and Endometrial Biopsy in Women with Unexplained Infertility","volume":"289","author":"Makled","year":"2014","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1111\/jog.15658","article-title":"Association of endometrial polyps with STC-1 and STC-2 in infertile patients","volume":"49","year":"2023","journal-title":"J. Obs. Gynaecol. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1023\/A:1020513423948","article-title":"The Effect of Endometrial Polyps on Outcomes of In Vitro Fertilization (IVF) Cycles","volume":"16","author":"Lass","year":"1999","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref_21","first-page":"8895","article-title":"The Association between Endometrial Polyps, Chronic Endometritis, and IVF Outcomes","volume":"27","author":"Vaduva","year":"2023","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.ejogrb.2021.11.420","article-title":"The Effects of Hysteroscopic Morcellation of Endometrial Polyps on Frozen Embryo Transfer Outcomes","volume":"267","author":"Kavoussi","year":"2021","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.rbmo.2016.12.012","article-title":"Management of Endometrial Polyps Incidentally Diagnosed during IVF: A Case-Control Study","volume":"34","author":"Yang","year":"2017","journal-title":"Reprod. Biomed. Online"},{"key":"ref_24","first-page":"299","article-title":"Endometrial Polyps and Their Relationship in the Pregnancy Rates of Patients Undergoing Intrauterine Insemination","volume":"39","author":"Kalampokas","year":"2012","journal-title":"Clin. Exp. Obstet. Gynecol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1111\/jog.13571","article-title":"Hysteroscopy after Repeated Implantation Failure of Assisted Reproductive Technology: A Meta-Analysis","volume":"44","author":"Cao","year":"2018","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/j.jmig.2023.06.010","article-title":"A Controversial Old Topic Revisited: Should Diagnostic Hysteroscopy Be Routinely Performed Prior to the First IVF Cycle? A Systematic Review and Updated Meta-Analysis","volume":"30","author":"Alonso","year":"2023","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1097\/GCO.0000000000000277","article-title":"Hysteroscopic Polypectomy for Women Undergoing IVF Treatment: When Is It Necessary?","volume":"28","author":"Kodaman","year":"2016","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2622","DOI":"10.1016\/S0140-6736(16)00231-2","article-title":"Hysteroscopy before In-Vitro Fertilisation (inSIGHT): A Multicentre, Randomised Controlled Trial","volume":"387","author":"Smit","year":"2016","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Guideline Group on Unexplained Infertility, Romualdi, D., Ata, B., Bhattacharya, S., Bosch, E., Costello, M., Gersak, K., Homburg, R., Mincheva, M., and Norman, R.J. (2023). Evidence-Based Guideline: Unexplained Infertility\u2020. Hum. Reprod., 38, 1881\u20131890.","DOI":"10.1093\/humrep\/dead150"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"ESHRE Working Group on Recurrent Implantation Failure, Cimadomo, D., de Los Santos, M.J., Griesinger, G., Lainas, G., Le Clef, N., McLernon, D.J., Montjean, D., Toth, B., and Vermeulen, N. (2023). ESHRE Good Practice Recommendations on Recurrent Implantation Failure. Hum. Reprod. Open, 2023, Hoad023.","DOI":"10.1093\/hropen\/hoad023"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2614","DOI":"10.1016\/S0140-6736(16)00258-0","article-title":"Hysteroscopy in Recurrent in-Vitro Fertilisation Failure (TROPHY): A Multicentre, Randomised Controlled Trial","volume":"387","author":"Campo","year":"2016","journal-title":"Lancet"},{"key":"ref_32","first-page":"e37470","article-title":"Hysteroscopic Identification of Intrauterine Pathology in Oocyte Donation Cycles: A Retrospective Study","volume":"15","author":"Peitsidis","year":"2023","journal-title":"Cureus"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.fertnstert.2023.02.036","article-title":"Does Maternal Age Affect Assisted Reproduction Technology Success Rates after Euploid Embryo Transfer? A Systematic Review and Meta-Analysis","volume":"120","author":"Vitagliano","year":"2023","journal-title":"Fertil. Steril."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Cimadomo, D., Fabozzi, G., Vaiarelli, A., Ubaldi, N., Ubaldi, F.M., and Rienzi, L. (2018). Impact of Maternal Age on Oocyte and Embryo Competence. Front. Endocrinol., 9.","DOI":"10.3389\/fendo.2018.00327"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/16\/4755\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:35:52Z","timestamp":1760110552000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/16\/4755"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,13]]},"references-count":34,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["jcm13164755"],"URL":"https:\/\/doi.org\/10.3390\/jcm13164755","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,13]]}}}