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Cited by 188Cervical Cancer and HPV ResearchReproductive Health and ContraceptionPreterm Birth and Chorioamnionitis

Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis

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Kyrgiou, M., Mitra, A., Arbyn, M., Stasinou, S. M., Martin-Hirsch, P., Bennett, P., Paraskevaidis, E.·2014·BMJ
DOI 10.1136/bmj.g6192PMC PMC4212006
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Abstract

OBJECTIVE: To determine the impact of cervical excision for cervical intraepithelial neoplasia on fertility and early pregnancy outcomes. DESIGN: Systematic review and meta-analysis of cohort studies. DATA SOURCES: Medline and Embase. ELIGIBILITY CRITERIA: Studies assessing fertility and early pregnancy outcomes in women with a history of treatment for cervical intraepithelial neoplasia versus untreated women. We classified the included studies according to treatment type and fertility or early pregnancy endpoint. ANALYSIS: Pooled relative risks and 95% confidence intervals using a random effect model, and interstudy heterogeneity with I(2) statistics. RESULTS: 15 studies fulfilled the inclusion criteria and were included. The meta-analysis did not provide any evidence that treatment for cervical intraepithelial neoplasia adversely affected the chances of conception. The overall pregnancy rate was higher for treated women than for untreated women (four studies; 43% v 38%, pooled relative risk 1.29, 95% confidence interval 1.02 to 1.64), although the heterogeneity between studies was high (P<0.0001). Pregnancy rates did not differ between women with an intention to conceive (two studies; 88% v 95%, 0.93, 0.80 to 1.08) and the number requiring more than 12 months to conceive (three studies, 15% v 9%, 1.45, 0.89 to 2.37). Although the rates for total miscarriages (10 studies; 4.6% v 2.8%, 1.04, 0.90 to 1.21) and miscarriage in the first trimester (four studies; 9.8% v 8.4%, 1.16, 0.80 to 1.69) was similar for treated and untreated women, cervical treatment was associated with a significantly increased risk of miscarriage in the second trimester. The rate was higher for treated women than for untreated women (eight studies; 1.6% v 0.4%, 16,558 women; 2.60, 1.45 to 4.67). The number of ectopic pregnancies (1.6% v 0.8%; 1.89, 1.50 to 2.39) and terminations (12.2% v 7.4%; 1.71, 1.31 to 2.22) was also higher for treated women. CONCLUSION: There is no evidence suggesting that treatment for cervical intraepithelial neoplasia adversely affects fertility, although treatment was associated with a significantly increased risk of miscarriages in the second trimester. Research should explore mechanisms that may explain this increase in risk and stratify the impact that treatment may have on fertility and early pregnancy outcomes by the size of excision and treatment method used.

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Authors
Kyrgiou, M., Mitra, A., Arbyn, M., Stasinou, S. M., Martin-Hirsch, P., Bennett, P., & Paraskevaidis, E.
Affiliations
  • Imperial College London (GB)
  • Institut Scientifique de Santé Publique (BE)
  • University Hospital of Ioannina (GR)
Corresponding author
Kyrgiou, M.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2014-10-28
Volume
349
Issue
oct28 1
Pages
g6192-g6192
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj.g6192
PMC
PMC4212006
OpenAlex
W2068487799
Cited by
188
References
4
Citations by year
2026: 8 · 2025: 16 · 2024: 29 · 2023: 12 · 2022: 13 · 2021: 13 · 2020: 8 · 2019: 14 · 2018: 15 · 2017: 18 · 2016: 29 · 2015: 10 · 2014: 3
FWCI
2.67
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • CLOK (University of Central Lancashire) (acceptedVersion)
  • HighWire Press Open Archive (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion, cc-by-nc)
Funders
National Institute for Health and Care Research (ACF-2014-21-012)
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 › Epidemiology › Preterm Birth and Chorioamnionitis
Keywords
cervical intraepithelial neoplasia, cervical excision, fertility, early pregnancy outcomes, miscarriage, ectopic pregnancy, pregnancy rate, second-trimester miscarriage, abortion, cervical cancer prevention, pregnancy loss risk
MeSH terms
Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Cervix Uteri, Female, Fertility, Humans, Postoperative Complications, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Models, Statistical, Pregnancy Rate, Conization

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