Can endometrial polyps affect pregnancy?

Endometrial polyps are localized hyperplasias originating from the basal layer of the endometrium, protruding into the uterine cavity on a pedicle. They may cause irregular vaginal bleeding, spotting before or after menstruation, menorrhagia (excessively heavy menstrual flow), and prolonged menstrual periods.

In general, small endometrial polyps—less than 1 cm in size and solitary or limited to one or two in number—typically do not impair fertility. However, larger polyps (>1 cm) or multiple polyps can adversely affect conception.

Particularly when polyps progressively increase in number or size, their location becomes critical. Polyps situated at the internal cervical os may impede sperm entry into the uterine cavity; those near the tubal ostia may interfere with sperm-egg interaction. When located within the uterine cavity, polyps may compromise endometrial receptivity, thereby hindering blastocyst implantation. Even if implantation occurs, the abnormal tissue architecture of the polyp—distinct from normal endometrium—may lead to inadequate blood supply, increasing the risk of embryonic developmental arrest and miscarriage. Thus, endometrial polyps can negatively impact fertility and elevate the risk of infertility or recurrent pregnancy loss. For patients experiencing infertility or recurrent miscarriage, hysteroscopic evaluation is recommended. If endometrial polyps are identified, surgical removal is advised prior to attempting conception.