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BMJ. 2014 Oct 28;349:g6192. doi: 10.1136/bmj.g6192.

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

Author information

1
Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London W12 0NN, UK m.kyrgiou@imperial.ac.uk.
2
Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London W12 0NN, UK.
3
Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Brussels.
4
Create Infertility Clinic, London, UK Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece.
5
Department of Gynaecologic Oncology, Lancashire Teaching Hospitals, Preston, UK Department of Biophotonics, Lancaster University, Lancaster, UK.
6
Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece.

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.

PMID:
25352501
PMCID:
PMC4212006
DOI:
10.1136/bmj.g6192
[Indexed for MEDLINE]
Free PMC Article

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