A. What is endometrial polyp? Endometrial polyp is a limited hyperplasia of the endometrium formed under the long-term and continuous effect of estrogen, consisting of endometrial glands, thick-walled blood vessels and interstitium, forming a tipped fleshy neoplasm that protrudes into the uterine cavity. In recent years, the incidence of endometrial polyps has been increasing year by year, and it has been reported that the detection rate of endometrial polyps in women with primary infertility can be as high as 50% or more. One study showed that the incidence was about 3% in women under 35 years of age, rising to 23% after 35 years of age. In my residency days, the age of menarche for girls was 13-14 years old, but now it has advanced to about 11 years old, and the age of menopause was about 45 years old then, and now it is after 50 years old. The significantly longer exposure of women to estrogen, coupled with the presence of many estrogen-like substances among chemical pollutants in the environment, has led to a significant increase in the incidence of estrogen-related diseases, such as endometrial polyps, endometrial cancer, uterine fibroids, and benign and malignant tumors of the breast. In fact, the best way to solve the root cause of this kind of tangle of pregnancy preparation is to have children early and have more children (next time, I will write an article on the “benefits of pregnancy and childbirth”). Having children early is not as much of a problem because young women have a low incidence of endometrial polyps and fibroids. Having children more often gives extra protection from progesterone, and the long-term effects of progesterone in a single ten-month pregnancy will reduce the incidence of most estrogen-related gynecological diseases. The majority of endometrial polyps are benign, but a few are malignant. Some researchers have found through more than a decade of follow-up studies that more than 95% of endometrial polyps are benign lesions, about 1.3% are precancerous, and 3.5% will be malignant. Factors associated with the development of malignancy include older age, late menopause, and the presence of clinical symptoms. In addition to the above factors, multiple polyps, endometriosis, obesity, diabetes, and hypertension also increase the probability of endometrial polyp malignancy. Third, will endometrial polyps affect pregnancy? The relationship between endometrial polyps and fertility lacks a large sample of multicenter studies. One randomized controlled study found that endometrial polypectomy significantly improved the pregnancy success rate of intrauterine insemination (IUI). As to whether endometrial polyp removal can improve the pregnancy success rate of in vitro fertilization (IVF), there are still no reliable conclusions due to the relatively small number of studies and small sample size. Do endometrial polyps increase the probability of miscarriage? There are no multicenter studies with large samples to suggest whether endometrial polyps increase the probability of miscarriage. V. In which cases do endometrial polyps need to be surgically removed before pregnancy? For small and asymptomatic endometrial polyps, expectant treatment is usually advisable, and spontaneous regression can occur in 25% of patients with endometrial polyps less than 10 mm. However, in infertile women, especially with larger polyps and multiple polyps, endometrial polyp removal is recommended to increase the probability of natural or artificially assisted conception, and hysteroscopic endometrial polyp removal remains the gold standard of surgical treatment. Hysteroscopic polypectomy should usually be considered for recurrent spontaneous abortions without other obvious causes.