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Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis

Title: Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis
Authors: Kyrgiou, M
Mitra, A
Arbyn, M
Stasinou, SM
Martin-Hirsch, P
Bennett, P
Paraskevaidis, E
Item Type: Journal Article
Abstract: Objective To determine the impact of cervical excision for cervical intraepithelial neoplasia on fertility and early pregnancy outcomes. Design Systematic review and meta-analysis of cohort studies. Data sources Medline and Embase. Eligibility criteria Studies assessing fertility and early pregnancy outcomes in women with a history of treatment for cervical intraepithelial neoplasia versus untreated women. We classified the included studies according to treatment type and fertility or early pregnancy endpoint. Analysis Pooled relative risks and 95% confidence intervals using a random effect model, and interstudy heterogeneity with I2 statistics. Results 15 studies fulfilled the inclusion criteria and were included. The meta-analysis did not provide any evidence that treatment for cervical intraepithelial neoplasia adversely affected the chances of conception. The overall pregnancy rate was higher for treated women than for untreated women (four studies; 43% v 38%, pooled relative risk 1.29, 95% confidence interval 1.02 to 1.64), although the heterogeneity between studies was high (P<0.0001). Pregnancy rates did not differ between women with an intention to conceive (two studies; 88% v 95%, 0.93, 0.80 to 1.08) and the number requiring more than 12 months to conceive (three studies, 15% v 9%, 1.45, 0.89 to 2.37). Although the rates for total miscarriages (10 studies; 4.6% v 2.8%, 1.04, 0.90 to 1.21) and miscarriage in the first trimester (four studies; 9.8% v 8.4%, 1.16, 0.80 to 1.69) was similar for treated and untreated women, cervical treatment was associated with a significantly increased risk of miscarriage in the second trimester. The rate was higher for treated women than for untreated women (eight studies; 1.6% v 0.4%, 16 558 women; 2.60, 1.45 to 4.67). The number of ectopic pregnancies (1.6% v 0.8%; 1.89, 1.50 to 2.39) and terminations (12.2% v 7.4%; 1.71, 1.31 to 2.22) was also higher for treated women. Conclusion There is no evidence suggesting that treatment for cervical intraepithelial neoplasia adversely affects fertility, although treatment was associated with a significantly increased risk of miscarriages in the second trimester. Research should explore mechanisms that may explain this increase in risk and stratify the impact that treatment may have on fertility and early pregnancy outcomes by the size of excision and treatment method used.
Issue Date: 28-Oct-2014
Date of Acceptance: 3-Oct-2014
URI: http://hdl.handle.net/10044/1/27418
DOI: 10.1136/bmj.g6192
ISSN: 1468-5833
Publisher: BMJ Publishing Group
Start Page: 1
End Page: 17
Journal / Book Title: British Medical Journal
Volume: 349
Issue: 10
Copyright Statement: © 2015 The Authors. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Sponsor/Funder: Imperial Health Charity
Imperial College Healthcare Charity
British Society for Colposcopy and Cervical Pathology
Funder's Grant Number: 7114/R17R
N/A
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
LARGE-LOOP EXCISION
PRETERM BIRTH
WOMEN
RISK
CONIZATION
CANCER
CONE
COMPLICATIONS
COLPOSCOPY
MORTALITY
Cervical Intraepithelial Neoplasia
Cervix Uteri
Conization
Female
Fertility
Humans
Models, Statistical
Postoperative Complications
Pregnancy
Pregnancy Complications
Pregnancy Outcome
Pregnancy Rate
Uterine Cervical Neoplasms
Cervix Uteri
Humans
Cervical Intraepithelial Neoplasia
Pregnancy Complications
Postoperative Complications
Conization
Pregnancy Outcome
Pregnancy Rate
Models, Statistical
Fertility
Pregnancy
Uterine Cervical Neoplasms
Female
General & Internal Medicine
1103 Clinical Sciences
1117 Public Health and Health Services
Publication Status: Published
Article Number: g6192
Appears in Collections:Department of Metabolism, Digestion and Reproduction
Faculty of Medicine