Fertility and pregnancy outcome after treatment for cervical intraepithelial neoplasia

Fertility and pregnancy outcomes are important concerns of reproductive-age women undergoing treatment for cervical intraepithelial neoplasia (CIN). Despite this concern, very few controlled studies are examining this relationship. With the exception of large-cone biopsies, no evidence confirms that commonly used treatment modalities for CIN have a detrimental effect on fertility. Some CIN treatments are reported to be associated with preterm deliveries, low birth weight, and an increase in instrumental deliveries. Because smoking and low socioeconomic status are also associated with CIN, the value of any study not controlling for these factors is limited. Large-cone biopsies are associated with increased numbers of preterm deliveries and midtrimester pregnancy losses. The relationship of smaller-cone biopsies to preterm delivery is controversial. Cryotherapy does not affect pregnancy outcome, but the evidence is limited. Stronger evidence shows no difference in pregnancy outcome after laser surgery or electrosurgical loop excision. To be valuable, future studies should control for smoking and socioeconomic factors.