Impact of hysteroscopic polypectomy via a tissue removal system on single frozen euploid blastocyst transfer outcomes

Background To determine whether hysteroscopic polypectomy with a tissue removal system affects frozen embryo transfer outcomes among a study population that underwent euploid single frozen blastocyst transfer with endometrial preparation via exogenous estradiol administration when compared with those without endometrial polyps who underwent single frozen blastocyst transfer with same type of endometrial preparation. Methods Retrospective chart review. Data from first frozen embryo transfer charts were reviewed. After inclusion and exclusion criteria, data abstracted from 218 cases. Group A: women who underwent hysteroscopic polypectomy via a tissue removal system within 5 months preceding a first euploid single frozen embryo transfer cycle (n = 60). Group B: women who did not have hysteroscopic polypectomy since endometrial polyps were ruled out prior to a first euploid single frozen embryo transfer cycle (n = 158). The primary outcome was live birth rate (LBR). Secondary outcome measures were positive pregnancy test rate (PPR), clinical pregnancy rate (CPR), and spontaneous miscarriage (SAB) rate via bivariate associations and multivariable logistic regression analyses. Results Bivariate analyses showed no differences between groups in LBR (A: 58.3%, 35/60 and B: 51.3%, 81/158, p-value = 0.43), PPR (A: 75.0%, 45/60 and 74.1%, 117/158; p-value = 0.98), CPR (A: 71.7%, 43/60 and B: 62.0%, 98/158; p-value = 0.24), or SAB rate (A: 22.2%, 10/45 and 30.8%, 36/117; p = 0.38). Multivariate multivariable analysis showed no difference in primary and secondary outcomes. Conclusions In patients undergoing single frozen embryo transfer with trophectoderm-tested euploid blastocysts, hysteroscopic polypectomy via a tissue removal system did not impact PPR, SAB rate, CPR, and LBR. Among patients with a positive pregnancy test resulting from euploid single frozen embryo transfer, previous hysteroscopic polypectomy via the tissue removal system predicted CPR but was not a predictor of LBR. Plain Engligh Summary: Our study indicates that hysteroscopic polyp removal, specifically with a tissue removal system, does not affect subsequent frozen embryo transfer outcomes when compared with cases of frozen embryo transfer in women without endometrial polyps when one chromosomally normal blastocyst stage embryo is transferred to the uterus within a short period of time thereafter.