A prospective study of treatments for cervical intraepithelial neoplasia and fecundability
Open accessAbstract
BACKGROUND: Treatments for cervical intraepithelial neoplasia remove precancerous cells from the cervix by excising or ablating the transformation zone. Most studies show no association between cervical intraepithelial neoplasia treatments and fertility outcomes. However, only 2 studies have examined time to pregnancy, both using retrospective study designs, with 1 study showing no association and the other showing a 2-fold increased risk of infertility (time to pregnancy >12 months) following excisional or ablative treatment. OBJECTIVE: We examined the association between cervical intraepithelial neoplasia treatments and fecundability. MATERIALS AND METHODS: We analyzed data from Pregnancy Study Online (PRESTO), a prospective cohort study of North American pregnancy planners enrolled during 2013-2019. At baseline, women reported whether they ever had an abnormal Papanicolaou test result, the number of abnormal Papanicolaou test results, and their age at first abnormal Papanicolaou test result. They also reported whether they underwent diagnostic (colposcopy) or treatment (excisional or ablative) procedures, and their age at each procedure. We restricted analyses to 8017 women with 6 or fewer cycles of attempt time at enrollment who reported receiving a Papanicolaou test in the previous 3 years. We estimated fecundability ratios and 95% confidence intervals using proportional probabilities models adjusted for sociodemographics, healthcare use, smoking, number of sexual partners, history of sexually transmitted infections, and human papillomavirus vaccination. RESULTS: A history of abnormal Papanicolaou test results showed little association with fecundability (fecundability ratio, 1.00; 95% confidence interval, 0.95-1.06). Likewise, receipt of colposcopy or treatment procedures, and time since treatment were not materially associated with fecundability. Results were similar when stratified by age and smoking status. CONCLUSION: We observed no appreciable association of self-reported history of abnormal Papanicolaou test results, colposcopy, treatments for cervical intraepithelial neoplasia, or recency of treatment with fecundability. These results agree with the majority of previous studies in indicating little effect of cervical intraepithelial neoplasia treatments on future fertility.
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The effect on fertility of ablative therapies such as cryotherapy or laser vaporisation was assessed only in three studies in high-income countries.
“The effect on fertility of ablative therapies such as cryotherapy or laser vaporisation was assessed only in three studies in high‐income countries [13, 14, 15].”
From Fertility and Miscarriage Incidence After Cervical Intraepithelial Neoplasia Treatment by Thermal Ablation: A Cohort Study (2025) · cites this paper as [15]
Two cohort studies in North America assessed pregnancy rates following ablative treatment, showing either increased pregnancy rates for grouped ablative procedures including thermal cautery, or no significant effect for laser treatment and cryotherapy.
“More recently, two cohort studies in North America assessed pregnancy rates following ablative treatment, showing either increased pregnancy rates for grouped ablative procedures, including thermal cautery [24], or no significant effect for laser treatment and cryotherapy [15].”
From Fertility and Miscarriage Incidence After Cervical Intraepithelial Neoplasia Treatment by Thermal Ablation: A Cohort Study (2025) · cites this paper as [15]
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- Authors
- Wise, L. A., Willis, S. K., Perkins, R. B., Wesselink, A. K., Klann, A., Crowe, H. M., Hahn, K. A., Mikkelsen, E. M., & Hatch, E. E.
- Affiliations
- Boston University (US)
- Aarhus University (DK)
- Corresponding author
- Wise, Lauren A.
- ORCID
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 223
- Issue
- 1
- Pages
- 96.e1-96.e15
- ISSN
- 0002-9378 (ISSN-L)
- PMC
- PMC8041134
- OpenAlex
- W2998673070
- Cited by
- 14
- References
- 47
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 5 · 2022: 2 · 2021: 1
- FWCI
- 0.57
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R21-HD072326, R01-HD086742, R03-HD094117)
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Keywords
- cervical intraepithelial neoplasia, fecundability, fertility, time to pregnancy, excisional treatment, ablative treatment, colposcopy, human papillomavirus, smoking
- MeSH terms
- Adult, Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Female, Fertility, Humans, Prospective Studies
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