COMMENTARY

Treatment for HPV Lesions May Affect Fertility

Peter Kovacs, MD, PhD

Disclosures

October 08, 2013

Cervical Surgery for Cervical Intraepithelial Neoplasia and Prolonged Time to Conception of a Live Birth: A Case-Control Study

Spracklen CN, Harland KK, Stegman BK, Saftlas AF
BJOG. 2013;120:960-965

Background

Cervical cancer is diagnosed in 7.9 per 100,000 women.[1] Most cervical cancers are associated with human papillomavirus (HPV) infection. These are well-characterized precursor lesions that may progress to cancer when left untreated.

Cervical cancer screening, especially when combined with HPV screening, is an effective tool to identify precursor lesions at a stage when treatment can be offered to prevent progression to invasive disease. Cervical cancer screening has resulted in a reduction of morbidity and mortality associated with cervical cancer.[2]

Precursor lesions may or may not require treatment. Most lesions regress spontaneously, on their own.[3] When treatment is offered, it involves cryoablation, laser vaporization, or excision of the affected area (loop electrosurgical excisional procedure [LEEP] or "cold knife" cone biopsy).

Surgery, however, affects the structure of the cervix and its physiologic function and may affect one's subsequent reproductive outcome. This case/control study assessed whether surgical treatment of cervical lesions has an impact on subsequent time to pregnancy.

Study Summary

The database of the Iowa Health in Pregnancy Study, a population-based case/control study, served as the basis for the study population. After all inclusion and exclusion criteria were applied, 1324 women were included in the analysis for this study. Of these women, 77.1% of them had not received treatment for cervical lesions, whereas the rest were treated by 1 of 4 different methods (cryosurgery, laser vaporization, LEEP, cone biopsy). The various treatment modalities were grouped together. Data were collected on confounding variables (age, parity, gravidity, body mass index, race, education, smoking history).

In 9.4% of the analyzed population, it took over 1 year to achieve a pregnancy. The rate was 16% in the treated group and 8.4% in the control group. Women who needed longer to conceive (> 12 months) were less educated, had higher body mass index, were more likely to be smokers, and were more likely to have undergone cervical surgery.

Women who had colposcopy with punch biopsy only were not at an increased risk for prolonged time to pregnancy. Those with a history of cervical surgery, in contrast, were at an increased risk for prolonged (> 12 months) time to pregnancy, even after controlling for age, education, body mass index, smoking, and socioeconomic status (odds ratio, 2.09; 95% confidence interval, 1.26-3.46). The risk for preterm delivery was also higher among those who had undergone cervical surgery.

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