Le polype endométrial est une lésion hyperplastique localisée de l’endomètre, considérée comme l’une des plus fréquentes pathologies gynécologiques. Cependant, sa physiopathogénie est encore incomplètement élucidée, même si diverses anomalies biomoléculaires associées ont été récemment rapportées. Il peut entraîner des saignements anormaux, des douleurs et une infertilité. Son diagnostic a bénéficié des progrès de l’imagerie, mais l’hystéroscopie reste l’examen de référence. Son incidence varie selon l’âge, les symptômes et les critères diagnostiques retenus. L’association des polypes à l’infertilité ne manque pas de susciter de nombreuses questions. Une étude réalisée chez un primate confirme l’impact du polype sur la fertilité. Les données épidémiologiques montrent que les EP sont fréquents chez la femme infertile, avec une incidence variable selon le contexte clinique. Elle est encore plus élevée chez les patientes présentant une endométriose. Divers mécanismes tendant à expliquer l’altération de la fertilité ont été proposés, le plus pertinent semble être l’altération de la réceptivité endométriale. Les données thérapeutiques, longtemps limitées à des études observationnelles, sont aujourd’hui un peu plus consistantes, suggérant l’amélioration des performances reproductives après polypectomie. Finalement, compte tenu de l’innocuité de cette intervention, il paraît légitime de proposer son utilisation en cas de polype identifié chez une femme infertile, en particulier dans le contexte d’une assistance médicale à la procréation ; néanmoins, le niveau de preuve est encore limité, justifiant la réalisation d’études contrôlées rigoureuses.
Polype endométrial et hypofertilité : quels niveaux de preuve ?
Jul 11 2014 Rédaction-
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Comment Link Kinovi Team Monday, 10 August 2026 08:39
This is a very useful synthesis of the evidence on endometrial polyps and fertility. The distinction you draw between the solid data on polyp removal before ART and the more debatable benefit in spontaneous conception is particularly helpful for clinical decision-making. It would be interesting to see future studies stratify outcomes by polyp size and location, as these factors may ultimately refine the indications for hysteroscopic polypectomy.
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Comment Link Kinovi Team Monday, 10 August 2026 08:39
This is a very useful synthesis of the evidence on endometrial polyps and fertility. The distinction you draw between the solid data on polyp removal before ART and the more debatable benefit in spontaneous conception is particularly helpful for clinical decision-making. It would be interesting to see future studies stratify outcomes by polyp size and location, as these factors may ultimately refine the indications for hysteroscopic polypectomy.
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