title: Cervical surgery for cervical intraepithelial neoplasia and prolonged time to conception of a live birth: a case-control study.
abstract: OBJECTIVE
  To determine whether women with a history of surgery for cervical intraepithelial neoplasia (CIN) are at an increased risk of subfertility, measured as a time to pregnancy of more than 12 months.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Iowa Health in Pregnancy Study (IHIPS), a population-based case-control study of preterm and small-for-gestational-age (SGA) live birth outcomes (from May 2002 through June 2005) in the USA.
  
  
  METHODS
  Women with an intended pregnancy and a history of either one prior cervical surgery (n = 152), colposcopy only (n = 151), or no prior cervical surgery or colposcopy (n = 1021).
  
  
  METHODS
  Cervical treatment history, pregnancy intention, time to pregnancy, and other variables were self-reported by computer-assisted telephone interviews. Odds ratios were calculated using logistic regression to estimate the risk of prolonged time to pregnancy among women with a history of cervical surgery or colposcopy alone, compared with untreated women (control group).
  
  
  METHODS
  Prolonged time to pregnancy (i.e. >1 year).
  
  
  RESULTS
  Prolonged time to pregnancy was most prevalent among treated women (16.4%), compared with untreated women (8.4%) and women with colposcopy only (8.6%) (P = 0.039). After adjusting for covariates, women with prior cervical surgery had a more than two-fold higher risk of prolonged time to pregnancy compared with untreated women (aOR 2.09, 95% CI 1.26-3.46). In contrast, women with a history of colposcopy only had a risk equivalent to that found among untreated women (aOR 1.02, 95% CI 0.56-1.89).
  
  
  CONCLUSIONS
  Women with a history of cervical treatment for CIN are at increased risk of subfertility, measured as a time to pregnancy of more than 12 months.
authors.affiliation: Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA.
authors.forename: C N
authors.initials: CN
authors.lastname: Spracklen
authors.forename: K K
authors.initials: KK
authors.lastname: Harland
authors.forename: B J
authors.initials: BJ
authors.lastname: Stegmann
authors.forename: A F
authors.initials: AF
authors.lastname: Saftlas
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005306:Fertilization; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D007247:Infertility, Female / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D007484:Iowa; D050498:Live Birth; D008875:Middle Aged; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000601:surgery*; D015995:Prevalence; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000601:surgery*