A prospective study of treatments for cervical intraepithelial neoplasia and fecundability.

Abstract

BACKGROUND\nTreatments for cervical intraepithelial neoplasia remove pre-cancerous 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 two studies have examined time-to-pregnancy, both using retrospective study designs, with one showing no association and the other showing a two-fold increased risk of infertility (time-to-pregnancy>12 months) following excisional or ablative treatment.\n\n\nOBJECTIVE\nWe examined the association between cervical intraepithelial neoplasia treatments and fecundability.\n\n\nSTUDY DESIGN\nWe 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 (Pap) test, the number of abnormal Pap tests, and their age at first abnormal Pap test. They also reported whether they underwent diagnostic (colposcopy) or treatment (excisional or ablative) procedures, and their age at each procedure. We restricted analyses to 8,017 women with ≤6 cycles of attempt time at enrollment who reported receiving a Pap test in the previous 3 years. We estimated fecundability ratios (FR) and 95% confidence intervals (CI) using proportional probabilities models adjusted for sociodemographics, health care utilization, smoking, number of sexual partners, history of sexually transmitted infections, and human papillomavirus vaccination.\n\n\nRESULTS\nHistory of abnormal Pap test showed little association with fecundability (FR=1.00, 95% CI: 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.\n\n\nCONCLUSION\nWe observed no appreciable association of self-reported history of abnormal Pap test, 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.