Endometrial polyp is a common gynecological disorder, which is a localized overgrowth of the endometrium, either single or multiple, ranging from a few millimeters to several centimeters in diameter, and can be either non-tipped or tipped. Polyps are composed of endometrial glands, mesenchyme and blood vessels. Endometrial polyps are uncommon and risk factors for their development include age, hypertension, and obesity. Endometrial polyps can be asymptomatic, and when symptoms do occur, they usually include abnormal uterine bleeding and infertility. Most women with infertility have an unexpected finding of an endometrial polyp on ultrasound. Removal of endometrial polyps in infertile women can improve fertility. Because many endometrial polyps can be asymptomatic leading to their inexact prevalence. The reported prevalence of endometrial polyps ranges from 7.8% to 34.9%, and the incidence of endometrial polyps appears to be increased in infertile women. In a large prospective trial including 1000 infertile women who underwent in vitro fertilization, the prevalence of endometrial polyps was 32%. The high prevalence of endometrial polyps in infertile women suggests a causal relationship between endometrial polyps and infertility. Diagnosis 1. Transvaginal ultrasonography suggests that a typical endometrial polyp usually appears as a conventionally shaped hyperechoic lesion surrounded by a weak, strongly echogenic halo in the uterine cavity. Cystic cavities are seen within the polyps, and intrauterine polyps appear as a nonspecific endometrial thickening or localized mass. These ultrasonographic examinations are not specific and similar findings have been seen in other conditions such as myomas. Vaginal ultrasound findings may be more reliable during the proliferative phase of the menstrual cycle. Repeat ultrasound after menstruation may help to differentiate between “polypoid endometrium” and endometrial polyps, but the pathological diagnosis ultimately prevails. Blind examination Blind dilatation, curettage or endometrial biopsy is inaccurate for the diagnosis of endometrial polyps, so this technique should not be used for diagnosis. Blind examination can also lead to polyp fragmentation and difficult histological diagnosis. Hysteroscopy-guided biopsy is the most common method than other methods to diagnose polyps because it is the conservative measure with the highest sensitivity and specificity. Treatment 1. Conservative treatment Given that most polyps are nonmalignant, one approach is expectant therapy without intervention. Evidence suggests that approximately 25% of polyps regress spontaneously and that smaller polyps are more likely to regress compared to polyps greater than 10 mm in length. After discussing and informing with the patient, conservative treatment with observation is an option. 2. Drug therapy Drug therapy has limited effect on endometrial polyps. The use of certain types of hormone therapy may have a preventive effect on polyp formation. However, its use for polyp treatment is currently limited to research. 3. Conservative surgical treatment Studies have shown that removal of endometrial disease by blind scraping is less than 50% successful and in many cases incomplete. Blind curettage should not be used as a diagnostic or therapeutic intervention when hysteroscopic treatment is feasible. When endometrial polyps are diagnosed or suspected and hysteroscopy is not feasible, the patient should be converted to give the appropriate treatment. 4. Hysteroscopic electrosurgery Hysteroscopic polypectomy is effective and safe as a diagnostic and therapeutic intervention. There are various methods of hysteroscopic removal of polyps; however, the choice of these methods is related to the training and proficiency of the clinician. Since polypectomy does not involve the myometrium, the risk of uterine adhesions is low. 5. Clinical prognosis Polypectomy can be effective in improving fertility in women with low fertility, and pregnancy rates have been reported to vary between 43% and 80%. Removal of polyps prior to intrauterine insemination significantly improves the chances of successful repeat pregnancies, and 65% of women with polyps removed can conceive spontaneously before assisted reproductive techniques.