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

Fertility and early pregnancy outcomes after treatmentfor cervical intraepithelial neoplasia: systematic reviewand meta-analysisjurnalIntroductionCervical screening for the early identification and treatment of cervical intraepithelial neoplasia has reduced the incidence and mortality from cervical cancer.1 As the precancerous lesions and their treatment typically occur in women of reproductive age, the impact of conisation on the outcomes of subsequent pregnancies has been an area of active research for the past decade.Meta-analyses and large retrospective linkage studies suggest that the excisional methods of treatment (cold knife conisation, large loop excision of the transformation zone (LLETZ), and laser conisation) increase the risk of preterm birth, low birth weight, premature rupture of membranes, and perinatal mortality in subsequent pregnancies; cervical intraepithelial neoplasia itself and other confounders may contribute to that risk.Although the impact of treatment for cervical precancer on obstetric sequelae has been extensively described, its effect on the ability to conceive and early pregnancy outcomes has been relatively under-reported. Cervical excision removes part of the endocervical canal and as a result the mucus-secreting endocervical glands, which produce secretions facilitating penetration of the sperm and conception.This has been suggested to adversely affect the chances of conception. The loss of the normal functional cervical structure and the healing process in the regenerated crater after excision may also induce severe stenosis of the cervical os, which may further inhibit sperm penetration and conception.The impact that treatment may have on conception and childbearing causes anxiety to women requiring conisation. Although the impact of treatment on obstetric outcomes has been the subject of previous reports, there is little evidence on the effect that this has on the ability to conceive and early pregnancy outcomes, particularly the rate of miscarriages in the second trimester. The existing published data are limited, often contradictory, and poorly documented. In this systematic review and meta-analysis we assessed the effect of treatment for cervical intraepithelial neoplasia on fertility and early pregnancy outcomes.MethodsWe included all studies that compared fertility and early pregnancy (