Can endometrial polyps affect pregnancy?

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

If polyps measure less than 1 cm in diameter and are few in number—typically one or two—they generally do not impair fertility. However, larger polyps (>1 cm) or multiple polyps can adversely affect conception.

In particular, with progressive polyp growth, 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–oocyte interaction; and polyps within the uterine cavity may compromise endometrial receptivity, thereby hindering blastocyst implantation. Even if implantation occurs, the abnormal polypoid tissue—distinct from normal endometrium—may result in inadequate blood supply to the developing embryo, increasing the risk of embryonic 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.