Department of Epidemiology, Boston University School of Public Health, Boston, MA.
Department of Epidemiology, Boston University School of Public Health, Boston, MA.
Am J Obstet Gynecol. 2020 Jul;223(1):96.e1-96.e15. doi: 10.1016/j.ajog.2019.12.017. Epub 2019 Dec 28.
Treatments for cervical intraepithelial neoplasia remove precancerous cells from the cervix by excising or ablating the transformation zone. Most studies show no association between cervical intraepithelial neoplasia treatments and fertility outcomes. However, only 2 studies have examined time to pregnancy, both using retrospective study designs, with 1 study showing no association and the other showing a 2-fold increased risk of infertility (time to pregnancy >12 months) following excisional or ablative treatment.
We examined the association between cervical intraepithelial neoplasia treatments and fecundability.
We analyzed data from Pregnancy Study Online (PRESTO), a prospective cohort study of North American pregnancy planners enrolled during 2013-2019. At baseline, women reported whether they ever had an abnormal Papanicolaou test result, the number of abnormal Papanicolaou test results, and their age at first abnormal Papanicolaou test result. They also reported whether they underwent diagnostic (colposcopy) or treatment (excisional or ablative) procedures, and their age at each procedure. We restricted analyses to 8017 women with 6 or fewer cycles of attempt time at enrollment who reported receiving a Papanicolaou test in the previous 3 years. We estimated fecundability ratios and 95% confidence intervals using proportional probabilities models adjusted for sociodemographics, healthcare use, smoking, number of sexual partners, history of sexually transmitted infections, and human papillomavirus vaccination.
A history of abnormal Papanicolaou test results showed little association with fecundability (fecundability ratio, 1.00; 95% confidence interval, 0.95-1.06). Likewise, receipt of colposcopy or treatment procedures, and time since treatment were not materially associated with fecundability. Results were similar when stratified by age and smoking status.
We observed no appreciable association of self-reported history of abnormal Papanicolaou test results, colposcopy, treatments for cervical intraepithelial neoplasia, or recency of treatment with fecundability. These results agree with the majority of previous studies in indicating little effect of cervical intraepithelial neoplasia treatments on future fertility.
治疗宫颈上皮内瘤变通过切除或消融转化区来去除宫颈的癌前细胞。大多数研究表明宫颈上皮内瘤变的治疗与生育结局之间没有关联。然而，只有 2 项研究检查了妊娠时间，均采用回顾性研究设计，其中 1 项研究表明无关联，另一项研究表明切除或消融治疗后不孕的风险增加了 2 倍（妊娠时间>12 个月）。
我们检查了宫颈上皮内瘤变治疗与生育能力之间的关联。
我们分析了北美妊娠计划者于 2013 年至 2019 年期间参加的前瞻性队列研究妊娠研究在线（Presto）的数据。在基线时，女性报告她们是否曾有过异常巴氏涂片检查结果、异常巴氏涂片检查结果的数量以及首次异常巴氏涂片检查结果的年龄。她们还报告了是否接受过诊断（阴道镜检查）或治疗（切除或消融）程序，以及每次程序的年龄。我们将分析限制在 8017 名在入组时已有 6 个或更少周期尝试时间且在过去 3 年内接受巴氏涂片检查的女性中。我们使用比例概率模型估计生育能力比和 95%置信区间，该模型调整了社会人口统计学、医疗保健使用、吸烟、性伴侣数量、性传播感染史和人乳头瘤病毒疫苗接种情况。
异常巴氏涂片检查结果史与生育能力关系不大（生育能力比，1.00；95%置信区间，0.95-1.06）。同样，阴道镜检查或治疗程序的接受情况以及治疗后的时间与生育能力没有明显关联。按年龄和吸烟状况分层的结果相似。
我们观察到自我报告的异常巴氏涂片检查结果、阴道镜检查、宫颈上皮内瘤变治疗以及治疗的近期情况与生育能力之间没有明显关联。这些结果与大多数先前的研究一致，表明宫颈上皮内瘤变的治疗对未来的生育能力几乎没有影响。
