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HPV and fertility

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What impact does cervical HPV, or pre-cancerous cell changes, have on pregnancy or fertility?

This is one of the most common inquiries we receive at the National HPV and Cervical Cancer Prevention Resource Center. First we’ll cover some background.

Pre-cancerous cervical cell changes may be referred to with different terms, such as dysplasia, cervical intraepithelial neoplasia (CIN), or squamous intraepithelial neoplasia (SIL), all of which mean essentially the same thing: abnormal cell growth on the cervix. Cervical cell changes are usually first detected with a Pap test (cervical cytology), then typically confirmed with another procedure known as colposcopy/biopsy (this uses a special portable microscope to examine the cervix, and small tissue samples can be taken from any suspicious areas).

Cervical cytology results of dysplasia, CIN, or SIL are strongly suggestive of the presence of “high-risk” HPV types that are found with virtually all cervical cancers. Fortunately, few cases of “high-risk” HPV actually lead to cancer, especially with women who have regular Pap tests so that cell changes can be detected and, if needed, treated long before cancer is an issue. Most milder cases of cervical abnormalities will self-resolve, so woman are often managed with “watchful waiting” through frequent Pap tests, rather than treatment.

HPV, in itself, does not impact fertility and the risks of transmission to the baby during pregnancy or birthing is very, very low, so much so that cesarean delivery is rarely recommended solely due to either HPV infection or the presence of related lesions.

Recent changes to cervical cancer screening guidelines (see related article in News Desk) that recommend Pap testing not being until age 21 are due, in part, to recognition of pregnancy-related problems associated with the evaluation and treatment of borderline or mildly abnormal Pap tests. Sometimes treatment weakens the cervix and may affect a woman’s ability to carry a pregnancy to term, but this is usually not the case and most women are able to have children following cervical therapy – in fact, there are procedures (such as cervical cerclage, or “stitching”) that may help in some cases to restore the integrity of the cervix during pregnancy: To learn more, you can read a fact sheet on cervical cerclage from the University of Washington.

What about abnormal Pap test results during pregnancy? An abnormal Pap test in a pregnant patient seldom affects the course of the pregnancy. Some diagnostic procedures, such as cervical biopsy (although colposcopy can still be done) and any needed treatment for cervical cell changes in pregnant women are typically deferred until after delivery, unless the health care provider is concerned that cancer may be present and is so severe that treatment cannot be delayed. If cancer is found during pregnancy, the woman is referred to a specialist who will monitor her and keep her informed of how her delivery will be handled.