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Cervical surgery for cervical intraepithelial neoplasia and prolonged time to conception of a live birth: a case–control study
Author(s) -
Spracklen CN,
Harland KK,
Stegmann BJ,
Saftlas AF
Publication year - 2013
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12209
Subject(s) - medicine , obstetrics , colposcopy , cervical intraepithelial neoplasia , pregnancy , odds ratio , gynecology , logistic regression , population , gestational age , cervical cancer , cancer , environmental health , biology , genetics
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. Design Case–control study. Setting 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 . Sample 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). Main outcome measure 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.