title: Excisional treatments of the cervix and effect on subsequent fertility: a retrospective cohort study.
abstract: OBJECTIVE
  Concerns exist regarding the impact of excisional treatments for cervical intraepithelial neoplasia (CIN) on subsequent pregnancy outcome yet few studies have addressed fertility following surgery.
  
  
  METHODS
  Retrospective cohort study. Set in the colposcopy service of National Maternity Hospital. A postal questionnaire was sent to 3590 women of reproductive age who attended colposcopy from 2001 to 2007; 1795 of these had at least one excisional treatment (surgical group) and 1795 had no treatment (non-surgical group). Records were reviewed to confirm the clinical details and volume of tissue excised. The main outcome measures were pregnancy and fertility rates as well as time to conception correlated with volume of tissue excised. Students' t-test, Mann-Whitney U-test, spearman correlation and Kruskal-Wallis tests were used during the analysis.
  
  
  RESULTS
  1355 Women (37.7%) responded. 537 Women had no treatment and 818 had at least one excision. A subsequent pregnancy was reported in 730 women (434 surgical and 296 non-surgical groups). No difference was detected between the groups in the reported pregnancy rates (p=0.56), the time to conception (p=0.37) or fertility problems (p=0.89). The volume of the excision did not affect fertility rates or time to conception. There were fewer pregnancies in women following a cold knife cone or more than one LLETZ treatment-significant surgery, (p=0.004) but no difference in their reported time to conception (p=0.54).
  
  
  CONCLUSIONS
  One excisional treatment for CIN does not appear to affect subsequent fertility. Our study showed no delay in conception and no increased risk of problems conceiving in this group, even when controlling for the volume and depth of tissue removed. Women should be reassured by these results. Further work is required to evaluate the effect of cold knife cone biopsy and repeated LLETZ procedures on subsequent fertility.
authors.affiliation: Merrion Fertility Clinic/National Maternity Hospital, Dublin 2, Ireland. Electronic address: f_martyn@yahoo.com.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Martyn
authors.affiliation: UCD Obstetrics & Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland.
authors.forename: Fionnuala M
authors.initials: FM
authors.lastname: McAuliffe
authors.affiliation: Pathology Department, National Maternity Hospital, Dublin 2, Ireland.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Beggan
authors.affiliation: Pathology Department, National Maternity Hospital, Dublin 2, Ireland.
authors.forename: Paul
authors.initials: P
authors.lastname: Downey
authors.affiliation: Colposcopy Department/Gynae-Oncology, National Maternity Hospital/St Vincent's University Hospital, Dublin 2, Ireland.
authors.forename: Grainne
authors.initials: G
authors.lastname: Flannelly
authors.affiliation: Merrion Fertility Clinic/National Maternity Hospital, UCD Obstetrics & Gynaecology, School of Medicine and Medical Science, Dublin 2, Ireland.
authors.forename: Mary B
authors.initials: MB
authors.lastname: Wingfield
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000473:pathology / Q000601:surgery*; D019092:Conization / Q000009:adverse effects*; D004598:Electrosurgery / Q000009:adverse effects*; D005260:Female; D005298:Fertility; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D011247:Pregnancy; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery
keywords: Cervix; Excision; Fertility; Loop; Surgery