ESHRE 2025: The Association Between Endometriosis and Endometrial Polyps: A Systematic Review and Meta-Analysis

Study Question: What is the prevalence of endometrial polyps in women with endometriosis—and vice versa?

Summary Answer: There is a bidirectional association between endometriosis and endometrial polyps, particularly in infertile women.

What Is Known Already:

Endometriosis contributes to infertility and is associated with uterine comorbidities which may independently impact fertility by disrupting endometrial receptivity. However, the specific relationship between endometriosis and endometrial polyps has remained unclear.

Study Design, Size, Duration:

• Systematic review and meta-analysis
• 22 studies included
• 10,928 patients total (8,154 infertile women)
• Subgroup analyses stratified by:
  1. Infertility status
  2. Endometriosis severity (stage I–II vs. III–IV)
  3. Confirmation methods (surgical/histological)

Main Results:

1. Women with endometriosis had 2.18× higher risk of polyps (RR 2.18; 95% CI: 1.58–3.00)
2. Infertile women with endometriosis had even higher risk (RR 2.37)
3. With surgical/histological confirmation, RR rose to 2.53
4. Women with polyps also had greater risk of endometriosis (RR 2.05)
5. Gradient effect: Stage III–IV endometriosis increased risk of polyps vs. stage I–II (RR 1.19)
6. Compared to women without endometriosis, those with stage III–IV had nearly 3× risk of polyps (RR 2.97)

Limitations:

• Low evidence quality per GRADE
• High heterogeneity across studies (I² > 80% in several comparisons)
• Predominance of studies in infertile women may introduce selection bias

Wider Implications:

• Strong two-way association supports enhanced screening and tailored management
• May inform diagnostic guidelines and fertility care protocols
• Understanding shared mechanisms may offer novel therapeutic targets

ESHRE 2025, June 29 - July 2, Paris