- Facing a cervical cancer diagnosis during pregnancy
- Having Children After Cervical Cancer
- Fertility and Pregnancy After a LEEP
- Can you get pregnant after a LEEP?
- When can you start trying to conceive after a LEEP?
- I Had My Cervix Removed at 29—and I Can Still Get Pregnant
- HPV and Pregnancy: What You Need To Know
- Do I Have HPV?
- HPV and Abnormal Pap Smears
- Treatment of Cervical Abnormalities or Precancerous Cells
- Does HPV Affect Fertility?
- HPV and Pregnancy
- Should I Get the HPV Vaccine?
- What Did They Do To My Cervix?
- 1. Excisional procedures (removing part of the cervix)
- 2. Ablative procedures (the tissue stays in place but is “killed” through burning or freezing)
- Fertility after the procedure
- Rare surgical technique enables healthy pregnancy after cervical cancer
- Procedures to prevent cervical cancer do not affect fertility, study suggests
- What’s cervical cancer?
- How common is cervical cancer?
- What causes cervical cancer?
- Who’s at risk for cervical cancer?
- Will cervical cancer affect my fertility?
- What can I do to prevent cervical cancer?
Facing a cervical cancer diagnosis during pregnancy
“We were totally blown away,” Misty Wiggs says of finding out she was pregnant with her third child in April 2015.
For 12 years, Misty and her husband had thought that they couldn’t conceive any children. They’d adopted their first daughter in 2007. Six years later, Misty unexpectedly became pregnant with their second child. Still, it surprised the couple when another pregnancy test came back positive nearly two years later.
An overjoyed Misty set up an appointment with a new OB/GYN, who decided to perform a routine Pap test since it’d been two and half years since her last. When her Pap test results were abnormal, Misty wasn’t alarmed.
“My sister has had abnormal cells before and it was nothing, and I’d never had an abnormal test before that,” she says.
Misty’s doctor performed a colposcopy to get a closer look at the cells on her cervix. The results also came back abnormal. Her doctor immediately referred her to Nicole Fleming, M.D., at MD Anderson in Sugar Land.
“They got me in within two days,” says Misty, who was 10 weeks pregnant at the time. “Dr. Fleming was just very comforting. We just had a really good rapport from the first time we met.”
A cervical cancer diagnosis during pregnancy
Fleming repeated Misty’s colposcopy. When the results came back abnormal yet again, she scheduled a cone biopsy, which showed signs of cancer. So, Fleming performed another procedure called a cold knife conization.
Misty’s biopsies revealed that she had stage IA1 mixed squamous and adenocarcinoma of the cervix, a type of cervical cancer. It was caused by the human papillomavirus (HPV).
“I was crushed. I went to the OB/GYN because I found out that I was pregnant, and all the sudden, I had no idea what the future held for us,” she says.
Because the cold knife conization didn’t detect abnormal cells around the edges of the newly removed tissue, Fleming decided to just closely monitor Misty throughout the rest of her pregnancy.
A healthy baby despite cervical cancer
Misty spent the remainder of her pregnancy on modified bedrest and underwent a scheduled C-section at 38 weeks, giving birth to her son, Paxton, on Sept. 28, 2015.
“We call our first child our gift, the second one our miracle because we thought we couldn’t have any, and the third one our angel because he truly did save my life,” Misty says. “If I wasn’t pregnant with him, I don’t know when I would’ve gone to the doctor and gotten my next Pap test.”
After Misty had healed from her C-section, Dr. Fleming performed an endocervical biopsy and then a laparoscopic hysterectomy two weeks later.
During surgery, Fleming sent a portion of the cervix to pathology for a biopsy, and it came back positive. “There was more cancer there that we didn’t know about at the time,” Misty says. “But the spot that they found during surgery was the only spot, and it was small enough to where it didn’t require any further treatment or surgeries.”
Dealing with cervical cancer during pregnancy
For Misty, cervical cancer has been an emotional journey, especially because she purposely didn’t tell many people about her diagnosis until it was time for her hysterectomy.
“It was too hard to talk about it at the time. When you’re pregnant, you’re very emotional already, and early on, we didn’t know the prognosis and what it would come out to be like,” she says. “But Dr. Fleming presented my case to the rest of the gynecologic oncologists at MD Anderson each week, and they would all come up with a plan. I thought that was awesome. MD Anderson’s team followed my case the whole way, and I felt 100% confident in it.”
Now, she likes sharing her story with others to prove that happy endings are possible for women who receive a cancer diagnosis during pregnancy.
“Keep your faith and depend on your family and friends for any help that they have to offer. Keep fighting, and don’t ever give up,” she says. “We told ourselves that if he was meant to be, he’d make it through – and he sure did.”
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
Having Children After Cervical Cancer
Cancer treatments can affect fertility, making it difficult or even impossible to conceive. And this may be especially true of cervical cancer treatment. But keep in mind that infertility after cervical cancer is not inevitable. There are steps you can take to protect and preserve your fertility.
Cervical Cancer: Preserving Fertility
The most effective thing you can do to preserve your fertility? Get your yearly Pap smear.
“If patients don’t get their regular Pap smear screening and don’t get cervical cancer detected at an early stage, treatment may require a hysterectomy, which renders one infertile — completely,” says Jill Powell, MD, ob/gyn and adjunct associate professor of obstetrics and gynecology at Saint Louis University’s School of Medicine.
Cervical Cancer Treatment: How It Can Affect Fertility
Other cervical cancer treatments can have an impact, too. “Chemotherapy and radiation can also affect fertility,” says Debbie Saslow, PhD, director of breast and gynecologic cancer for the American Cancer Society.
If your uterus (womb) has been removed through a hysterectomy, you will not be able to carry a child. And if your ovaries are simultaneously removed, you no longer will produce eggs.
When cervical cancer treatment involves radiation therapy, high-energy rays are aimed at your pelvis to kill cancerous cells. This exposes your ovaries to radiation, which can damage them and destroy some or all of the eggs, resulting in premature menopause. In addition, women who have a uterus that has been exposed to radiation are at increased risk of miscarriage and premature births due to scarring and reduced blood flow to the uterus.
Since chemotherapy drugs kill healthy cells along with cancerous ones, there is a risk that they will damage some of the eggs that are stored in your ovaries. This can put you at risk of miscarriage and early menopause.
Even treatment for precancerous cells in the cervix can affect a woman’s ability to have children. “The treatment for precancer can weaken the cervix and affect a woman’s ability to carry the pregnancy to term,” says Dr. Saslow. These treatments include LEEP and cone biopsy procedures that remove a part of the cervix.
Dr. Powell adds that “the problem with these procedures is when you need to remove a larger portion of the cervix. The tissue left behind can scar shut, causing a condition known as cervical stenosis.” This condition prevents sperm and egg from meeting.
Having too much cervical tissue removed can cause the cervix to weaken, a condition known as cervical incompetence where “the cervix can open painlessly, even without contractions, and lead to miscarriage in the second or early third trimester,” says Powell. The fix is a stitch that holds the cervix closed, known as a cerclage, she explains.
Another issue is that if too many of the cervical glands, which are needed to make fluid for sperm movement through the cervix to the uterus, are removed, it can cause sperm to dry out and become unable to fertilize an egg. “The less tissue you can remove from the cervix, the better” for fertility, says Powell.
Fertility Options for Women with Cervical Cancer
It is important that you talk with your medical team about your options if you are about to undergo cervical cancer treatment and would like to have children. Here are points to consider in dealing with cervical cancer and preserving your fertility:
Catch it early. If you are being treated for precancerous cells of the cervix, discuss your options with your doctor. It may be feasible to remove the smallest amount of cervical tissue possible if your cancer is in its earliest stages. This can lower your risks of fertility-harming side effects like cervical stenosis and cervical incompetence.
Get a “trach.” Even in more advanced cases, your doctor may be able to perform a trachelectomy, a procedure that involves removal of the cervix while stitching the lower part of the uterus together. A trachelectomy leaves your uterus intact so you may still be able to carry a child. Pregnancy following this procedure will still involve reproductive technologies, according to Powell, but many women can have a successful pregnancy going this route.
Save an ovary. Your doctor may be able to spare one, or both, of your ovaries during a hysterectomy, which can both preserve your eggs and reduce menopausal symptoms. You would also have the option of harvesting one of your own eggs for a surrogate pregnancy; this is when another woman is impregnated with an embryo formed with your egg and sperm from your partner or a donor.
Consider your options. Some chemotherapy regimens are less likely to cause problems with fertility, depending on the type of medications, doses, and combinations, so talk about your options with your doctor. And various shields can be used with radiation, so discuss that with your doctor as well.
The Future Holds Promise for Women With Cervical Cancer
Fertility in women undergoing cervical cancer treatment “is definitely an issue that is being worked on,” says Saslow. “Some studies have been published that have shown positive results.”
For example, in an experimental procedure, researchers transplanted a woman’s ovary into her arm during cervical cancer treatment to protect the ovary from damage from radiation. Separate research is investigating the effectiveness of other approaches, such as shielding the ovaries during radiation and harvesting eggs before treatment.
What You Can Do Now
No matter what your situation, if your cervical cancer treatment is affecting your ability to have a child when you want one, it can be emotionally draining.
Adoption is a wonderful way to bring a child into your life, but grieving the loss of your potential to bear a biological child is difficult nonetheless.
Consider joining a support group where you will meet other women in your situation or talking with a therapist to help you cope during this challenging time.
“Long before you even think about getting pregnant, the best thing you can do to preserve your future fertility by avoiding cervical cancer is to get in the routine of having regular Pap smears,” says Powell. So check your calendar — are you due for yours?
Fertility and Pregnancy After a LEEP
It’s natural for women who are considering the loop electrosurgical excision procedure (LEEP) to be worried about the impact on their fertility and future pregnancies. This common method of removing abnormal cells from the cervix to prevent cancer does carry some risks, although they’re rare, says Dana Baras, M.D., M.P.H., a Gyn/Ob at Howard County General Hospital.
Wondering if you’ll have difficulty starting or growing your family because you’ve had a LEEP? Most women have no cause for concern, says Baras, who addresses the top questions women have about fertility and pregnancy problems after a LEEP.
Can you get pregnant after a LEEP?
There’s a small risk of scar tissue forming over the cervical opening (called cervical stenosis) after a LEEP. If the cervical passageway is narrowed or closed, this can cause irregular or absent periods or prevent sperm from getting through the cervix into the uterus to fertilize an egg. Cervical stenosis occurs rarely, although it’s more likely to happen if a greater amount of tissue needs to be removed during the procedure, or if you’ve had more than one LEEP.
After diagnostic tests such as colposcopy (in which a special microscope is used to view the cervix with a green filter light, allowing the doctor to look for changes and take a biopsy), your Gyn/Ob will determine how much tissue needs to be removed. This depends on where the abnormal cells are located.
When can you start trying to conceive after a LEEP?
Immediate recovery takes about two weeks. We recommend that women avoid sex or inserting anything into the vagina for four weeks. Full recovery of the cervix takes about six months. I usually tell my patients who have no evidence of cervical cancer to wait six months before trying to conceive.
How do you know the LEEP was effective?
To ensure that the abnormal cells have cleared, we recommend seeing your Gyn/Ob for a follow-up exam. Depending on the results of the pathology report, a patient may need additional testing such as a repeat Pap test, HPV testing, endocervical curettage (a type of biopsy inside the cervix) or even a hysterectomy.
I Had My Cervix Removed at 29—and I Can Still Get Pregnant
I didn’t tell many people about my diagnosis at first. I didn’t want anyone to be sad for me. If they were hugging me and crying for me, I would have completely broken down. It was my way of staying strong by protecting them. But eventually I told more people, including one of my managers (I also work as a gymnastics coach). She urged me to get a second opinion. I didn’t want to because I thought I already knew the game plan. But she kept nagging, so I agreed to do it.
I found another doctor online at Holy Name Medical Center in New Jersey who had experience in cervical cancer treatment and seemed to be involved in the community, which showed me that she was a caring person. She got me into her office very quickly. That was surprising; I had to wait so long for my other doctor appointments. She told me that while a radical hysterectomy would be safe for me, it wouldn’t allow me to grow my family. In my head I’m thinking, “Yeah, I already know this, but it’s my final option.”
But she said I had another option. She went on to explain the details of my tumor and my particular situation, which no other doctor had previously done. She understood I wasn’t done building my family, so she told me I was a perfect candidate for a radical tracheletomy instead. She explained the procedure: I would keep my uterus, and she would remove just my cervix and lymph nodes. Then, if I wanted to carry another child, I would have to get a cerclage, or a cervical stitch, to close the uterus to make sure the fetus didn’t fall out.
RELATED: 9 Cervical Cancer Symptoms Every Woman Needs to Know
I loved that she explained my tumor to me. It pushed me to go through all my paperwork so I could better understand my diagnosis and treatment. It was relieving that I had another option, but now I had to make a decision about what route to take: the very well-known route or the route that I had never heard about before. I wanted pregnancy to be an option, so I decided to go with the trachelectomy.
I had planned to tell my son about my diagnosis at the end of August, but that week we coincidentally had a family friend die of cervical cancer. He heard conversations about it, so he knew the words “cervical cancer” now; I couldn’t tell him I had the same disease. I waited until my surgery was coming up in September. I knew I couldn’t disappear and return home with a new scar without him knowing what’s going on. I told him the doctor said I had bad cells in my body that needed to be taken out so that I didn’t get sick.
The day of the surgery was rough. My surgery was supposed to be at 3 p.m. but ended up being at 7 p.m., and I couldn’t eat after midnight the night before. All the nurses and doctors were wonderful—my cousin was there with me, and my mom even tried to set me up on a date with the anesthesiologist. I became nauseous from the pain medication and got sick during the middle of the night. I was scared I was going to reopen the incision by vomiting, but the next morning, it was very relieving to find out that I didn’t have to be put together again. I didn’t have enough energy to talk very much.
To leave the hospital, I had to be able to walk. I couldn’t get very far at first, but each time I tried, I went a little farther. I came home with a catheter, which was very annoying and uncomfortable, especially in the shower. I had to leave extra early in the morning to take my son to school because I was walking so slowly so the bag wouldn’t fall off my leg.
RELATED: How Often Do You Really Need a Pap Test?
After surgery, my son was very happy that I couldn’t do much but stay home. He likes to jump on top of me; he was sad we weren’t able to do that while I recovered. I finally told him I had had a tumor, and we left it at that for some time. Later, he heard a commercial about cancer, and he asked me what it was. I described it to him, and he said, “Oh, like your tumor?” He put those things together himself. “That’s exactly what it was,” I explained. “Mommy had a tumor and that’s why doctors had to take it out.”
I didn’t say the word “cancer” to him until this past summer. I took a class at the hospital about how to talk to kids about cancer, which taught me that children are so young, they don’t have the same views that we do. Adults know so many sad stories; kids are so innocent that cancer is what we tell them.
I was given the green light to go back to work in the middle of November, but I still didn’t feel strong enough. It was very difficult, and I had to ask for a lot off help. I could not deal with my emotions. I asked my doctor to recommend some therapists, and I started doing yoga through a cancer survivor support group.
The green light to have sex took longer, about three months following my surgery. I can get pregnant normally, but mine would be a high-risk pregnancy, so I’d need a special ob-gyn. I’d also have to get the cerclage procedure before I’m too far along. I’m sure when the time comes, I’ll have a bunch of more questions that my doctors will happily answer.
I’ve started asking doctors for printed results of exams and tests, so I can read all the tiny details. It’s so important to pay attention to what your body is telling you and to follow through and ask the doctor a load of questions. Go get regular screenings, especially if you feel like there’s something going on in your body.
I’ve also started having these slow-motion movements like I’m in a movie, where I’m appreciating a beautiful sunset or snow falling or my son jumping through leaves. I was always very appreciative of the things I have and the people around me, but after surgery, I am really soaking in life. A friend of mine shared the perfect quote: “It doesn’t matter if your glass is half full or half empty. Be grateful that you even have a glass.”
Jane Martinez is partnering with the American Cancer Society, SU2C, Genentech, and Rally Health to promote awareness for cervical cancer screening during the annual Cancer Screen Week.
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HPV and Pregnancy: What You Need To Know
Short for human papillomavirus, HPV is an infection that can be transmitted sexually. There are more than 100 different strains of HPV; of those, about 40 are spread during sex and of those, about 15 can cause changes to cells in the cervix (the lower part of the uterus) that may lead to cervical cancer.
HPV is so common that up to 75 percent of women will contract it by age 50, says Bradley J. Monk, MD, an associate professor in the division of gynecologic oncology at the University of California Irvine School of Medicine. According to research from the University of Washington, HPV is so widespread that having even one sexual partner significantly raises your risk of contracting it. Almost 30 percent of women tested positive for HPV within a year of having sex with their first partner, the study showed.
Do I Have HPV?
Most people never know they have HPV, says Dr. Monk, because it is usually symptomless (a couple of strains may cause genital warts) and our bodies can easily fight off the infection over time. HPV can live in the body undetected for years without causing any side effects. But if the virus doesn’t go away on its own (which is more likely as you get older or if you have a weakened immune system), HPV can cause changes to the cells of the cervix, which may show up as abnormal results during a Pap smear.
Right now, experts don’t recommend getting tested for just HPV because the virus is so common – and usually harmless – and because simply knowing you have it isn’t all that helpful. Most women only learn they have HPV after they’ve received abnormal Pap results (a sign your body hasn’t fought off the virus). It’s becoming more common to do simultaneous Pap and HPV testing now, says Dr. Monk – so if your Pap turns up abnormal, the sample can then be screened for HPV without requiring an additional sample (and trek back to the doctor) from you. However, not all labs do this automatically, so you should check with your doctor’s office to be sure yours does.
- RELATED: Vaginal Infections During Pregnancy
HPV and Abnormal Pap Smears
Abnormal Pap results can mean a number of things, so don’t panic. First, know that between five and 10 percent of women who get yearly Paps will have abnormal results at some point. Sometimes, this is just because of a hard-to-read sample or because of another condition (like a recent yeast infection) that makes the results unclear. Even having sex, douching, or getting tested during or soon after your period can sometimes throw off results. In these cases, your doctor would likely just repeat the test.
If you have an abnormal Pap and test positive for HPV, your doctor will likely perform a colposcopy to learn more about the severity of the changes in your cervix. This procedure involves using a telescope-like tool to examine the cervix and to remove a small sample of cells to be biopsied in lab. From there, your doctor will have a better understanding of what kind of treatment, if any, you’ll need.
Thankfully, having an abnormal Pap smear doesn’t necessarily mean you’ll get cervical cancer. “There’s a huge spectrum here – from merely contracting HPV to actually getting cervical cancer, which is very, very rare, comparatively speaking,” says Dr. Monk. Here’s some perspective:
- Of all the millions of women who become infected with HPV, only about 10 percent will get a chronic infection their immune systems can’t fight off.
- Only a tiny fraction of those – maybe one in 100 – will get precancerous lesions (abnormal cells that could turn into cancer if left untreated).
- Of women with precancerous lesions, there are three basic levels of abnormalities. Most doctors won’t even treat the first, mildest level because the abnormal cells usually go away on their own.
- Treating the second two levels promptly usually means the abnormalities won’t have the chance to progress into full-blown cancer. Cervical cancer is pretty rare, and usually only affects women who don’t get Pap smears or see their doctor regularly.
- RELATED: Protecting Your Baby from STDs
Treatment of Cervical Abnormalities or Precancerous Cells
Treatment depends on a few things, including your age and the severity of the changes. With mild cases, most doctors adopt a wait-and-see approach with more frequent Pap smears and colposcopies to make sure your body’s healing and not getting worse. Women with more serious cases have the following options to consider:
- LEEP: An office procedure that uses an electric current to remove the abnormal cells from the cervix.
- Cone biopsy: A procedure in which a cone-shaped portion of the cervix (one that contains the precancerous cells) is removed. This is typically performed in a hospital or outpatient clinic under anesthesia.
- Freezing and laser: Called cryotherapy, this office procedure freezes the abnormal cells, which are then shed naturally.
Does HPV Affect Fertility?
The HPV virus alone shouldn’t have a huge impact on fertility. Although one study found that IVF patients who screened positive for HPV were less likely to become pregnant than those who tested negative, it’s not exactly clear why. Researchers speculate that an embryo may have a harder time implanting in a woman whose immune system is unable to clear the virus – but bear in mind that the vast majority of people with HPV fight it off shortly after contracting it.
However, being treated for precancerous cells may slightly raise your risk for problems conceiving. Procedures like cryotherapy, LEEP, and cone biopsy may narrow the cervix and change the consistency of your cervical mucus, both of which can slow sperm down and make it harder for them to reach and fertilize your egg. Even so, your overall risk of experiencing infertility is very low, says Dr. Monk. Though no studies have researched this area specifically, he estimates that these procedures might impact your ability to get pregnant by less than 5 percent. You’ll likely be advised to avoid sex for a month or so after having any of these procedures though, which could postpone conception.
- RELATED: What to Know About Infertility in Your 20s, 30s, and 40s
HPV and Pregnancy
Simply having the HPV virus in your system shouldn’t impact your pregnancy in most cases – and your baby won’t contract it. If you have genital warts caused by HPV, your doctor may watch you more closely, though women with this condition usually have healthy pregnancies and can even deliver vaginally.
However, treatments like LEEP or cone biopsy for precancerous cells can increase your chances of miscarriage or preterm birth, says Dr. Monk. These procedures raise your risk of cervical incompetence, where your cervix dilates too early. But your doctor can monitor your cervix through ultrasounds. He or she may recommend going on bed rest or a cerclage, a stitch that makes the cervix stronger, to prevent this from happening.
Should I Get the HPV Vaccine?
The HPV vaccine (Gardasil 9) is currently recommended for girls and women age 9 to 26 and men through age 21 —though the Federal Drug Administration (FDA) recently approved it for men and women aged 27 to 45. It has proven extremely effective at reducing HPV infection and, consequently, abnormal Pap results. The HPV vaccine can also reduce the transmission of genital warts and other cancers caused by HPV, including those of the penis, head, and neck.
A June 2019 study published in The Lancet reports that the benefits of the HPV vaccine are widespread. In fact, it shows that abnormal Pap smear results reduced by 50% in girls age 15-19 about five to nine years after they received the vaccine. The study also showed that the vaccine’s benefits extend to those who haven’t been vaccinated, since fewer people are carriers of HPV. Some experts hope that the vaccine could eliminate cervical cancer altogether.
RELATED: The HPV Vaccine: Health 101
The HPV vaccine protects against four of the most serious strains of HPV – the two that cause cervical cancer and two that cause genital warts. “But even if you’ve had abnormal Paps or tested positive for HPV, it’s still a good idea to get vaccinated, because there’s no way of knowing which strains you actually have,” says Dr. Monk.
Getting the HPV vaccine doesn’t completely eliminate your risk of getting cervical cancer, however. The vaccine protects against two strains that cause about 70 percent of cervical cancers, so even if you’re vaccinated, you can still contract other types – and you still need regular Pap screenings.
- By Lauren Gelman
What Did They Do To My Cervix?
I often see patients for an initial consult and while reviewing their gynecological history, they tell me they had an abnormal pap smear. The next question from me is what did the doctor do about it and have you had follow up pap smears? Most all patients have been followed up and many are now getting the thin prep pap as well as an HPV test. This is the most up to date recommendation. By detecting and treating early stage cervical dysplasia (abnormal cells), cervical cancer can be greatly reduced. Recent studies show an 80 percent reduction in cancer rates.
Most of the treatments are successful in terms of eradicating the cervical disease, but they may cause problems or damage to the cervix that could translate into infertility or premature delivery.
It is important for you to know what was done to your cervix. You may recognize your procedure from the following list, but you may need to get old medical records to make sure that you know what was done.
1. Excisional procedures (removing part of the cervix)
- Trachelectomy- removal of the entire cervix. This is a major surgery and usually done for cancer, not just precursors to cancer.
- Cone (Laser or Cold-knife). This is also a surgery, most often done in an operating room, with a laser and/ or scapel. A cone shaped portion of the cervix is removed, since that part of the cervix contained abnormal cells and is more sensitive to cancer formation. This is sent to pathology for a careful exam. This can weaken the cervix and remove the glands that produce the mucus. The mucus helps the sperm get to the egg.
- LEEP/LOOP. This is a procedure where an electrical current is passed through a wire and cuts out the abnormal cervical lesion. It can be a small amount or a large amount. The amount removed determines the remaining cervical strength and the mucus production.
2. Ablative procedures (the tissue stays in place but is “killed” through burning or freezing)
- Laser. A laser zaps the abnormal tissue, burning it.
- Cryotherapy. A freezing metal ball is using to freeze the abnormal tissue and then it will no longer divide.
- Electrocautery. The lesion is burned with a metal ball.
Fertility after the procedure
Most studies show no association between ablative procedures and infertility. Low birth rate and a possible risk of perinatal mortality were seen with the electrocautery in some studies. While infertility may not be hampered in most patients, there can be significant cervical mucus changes in some. If this is coupled with low sperm volume, spermicidal lubricants, or poor sperm quality, it may increase the time to conception. Most infertility doctors no longer do post-coital tests (as studies show little benefit from this awkward test). Instead, undergoing an insemination of sperm rather than timed intercourse may be helpful. The use of clomid also diminishes cervical mucus in most patients and may have an additive effect on the ablative therapy.
In regards to the excisional procedures, data is conflicting. Problems may be caused by some patients getting pregnant too soon after the therapy (it must not cause infertility for them!) and this may result in cervical incompetence or preterm delivery. Cerclages (a stitch placed around the cervix) may be needed to help keep the cervix from prematurely dilating. This is often done at 12 weeks of pregnancy or even before conception in some women. The opposite can also occur and cervical stenosis can cause labor to be abnormal more painful than it already is, or impossible to deliver vaginally. A meta-analysis in 2006 showed that fertility is not impaired after a LEEP. Cold knife cone has been shown to increase second trimester miscarriages by 7 times (1982 study), but newer studies have shown no increase risk. A recent meta-analysis by Arbyn in 2008 showed an increase in preterm labor and pregnancies complications.
Recent studies have also looked at progesterone injections to prevent preterm labor. This does not appear to be successful in the group of patients who are predisposed due to cervical surgery. Using the ultrasound to monitor the cervical length before and during early pregnancy may help but identifying the patients most at risk of cervical incompetence.
While more studies are needed to better understand the effect of cervical disease treatment on fertility, it is clear there are some risks. Being informed about your options and about the potential complications and risks is essential in taking charge of your fertility.
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Rare surgical technique enables healthy pregnancy after cervical cancer
From the time she was a young girl, Jennifer Zinga knew she wanted three children. By age 31, she and her husband had had two boys — and she was well on the way to achieving her dream family.
Then, just six months after her second son was born, she was diagnosed with early-stage cervical cancer. Her doctor recommended a hysterectomy, which would end her hopes of conceiving a third child.
“I remember hearing ‘cancer’ and ‘hysterectomy,’ and everything else was muffled, like I was underwater,” Zinga said. “My husband, Tim, and I were devastated by the news. But we weren’t ready to give up.”
The couple met with University of Chicago Medicine gynecologic oncologist Ernst Lengyel, MD, PhD, one of just a few physicians in the U.S. who performs a technically challenging surgery called trachelectomy. The innovative procedure involves removal of the cervix, while leaving most of the uterus intact.
“A trachelectomy allows us to balance treating the cancer with a patient’s desire to preserve fertility and carry a baby,” Lengyel said. “Fortunately, because the cervical cancer was at an early stage, Jennifer met the criteria for this procedure.”
The couple felt both comforted and excited.
“Dr. Lengyel and his staff were reassuring and positive,” Tim said. “And we had a glimpse of hope that Jen would be OK and that we could also have a third child.”
Jen had the procedure in June 2012.
“I remember waking up after surgery and asking Dr. Lengyel if all was OK and if we could have another baby,” she said. “He smiled and told me, ‘You are good to go.’”
We had a huge support group around us. We didn’t have to handle this on our own.
As she recovered from surgery, family and friends were there to help.
“We had a huge support group around us,” Tim said. “We didn’t have to handle this on our own.”
A year after surgery, Jen was pregnant. She delivered a healthy baby boy by caesarean section on April 7, 2014.
The first time Lengyel met the new baby was an emotional moment for all.
“We talk about the potential for success,” Lengyel said, “but to see and hold the success in my arms is a big difference. I’m happy that we delivered what we promised her.”
Today, Lengyel continues to monitor Jen to be sure the cancer has not returned. It’s been more than six years since the surgery, and she happily reports that she is cancer-free.
“Dr. Lengyel is the only reason we have Rocco, our miracle baby,” said Jen, who is now 37. “Along with our sons Giovani and Dominic, our family is now complete. We feel lucky, very lucky.”
Procedures to prevent cervical cancer do not affect fertility, study suggests
To the contrary, researchers found that women who had one of these procedures were actually more likely to become pregnant than women who did not have a procedure. The new Kaiser Permanente study was recently published in PLOS ONE.
According to the Centers for Disease Control and Prevention, about 3 million women in the United States will have an unclear or abnormal pap test each year. Many of them will go on to have a diagnostic colposcopy and biopsy to determine if they have pre-cancerous lesions on their cervix. If these lesions are found, the women may have a LEEP procedure, cryotherapy or another surgical procedure to remove the cells so they don’t progress to cervical cancer.
“This is great news for the millions of women who have one of these procedures, but still want to have a family,” said Allison Naleway, PhD, lead author and senior investigator at the Kaiser Permanente Center for Health Research in Portland, Oregon. “There was a fear that these procedures could weaken the cervix, and reduce fertility, but our study suggests that this is not the case.”
The researchers examined medical records for 4,137 women between the ages of 14 and 53 who were members of the Kaiser Permanente health plan in the states of Oregon and Washington between 1998 and 2009 and who had had a cervical treatment procedure. They followed the women for up to 12 years after the procedure to find out if they became pregnant. The researchers compared those women to 81,435 women in the health plan who did not have a cervical treatment procedure and 13,676 who had a colposcopy or biopsy diagnostic procedure.
Fourteen percent of women who had cervical treatment procedures got pregnant, compared to 9 percent of women who did not have a procedure and 11 percent of women who had a biopsy or colposcopy. After adjusting for age, contraceptive use and infertility, women who had a treatment procedure were still almost 1.5 times more likely to conceive compared to untreated women. Pregnancy rates among women who had a biopsy or colposcopy were the same as rates among women who had a surgical treatment procedure.
“While the data we collected did not include sexual history, it is possible that the women who had these procedures may have been more sexually active than the untreated group, and that would explain the higher pregnancy rates,” Naleway said.
This is the largest study to date to examine whether these surgical procedures decrease fertility. Other, smaller studies have relied on patient recall and survey data rather than examination of medical records, which was what Naleway used for her study.
Researchers also examined whether these procedures affected birth outcomes such as preterm delivery. Results of that study are expected later this year.
Cervical cancer is cancer of the cervix. It’s caused by some types of HPV, a common sexually transmitted infection. It can be prevented by getting the HPV vaccine, early detection, and treatment.
What’s cervical cancer?
Cervical cancer is cancer of the cervix. The cervix is the lower, narrow opening of the uterus. It leads from your uterus to your vagina. Your cervix looks kind of like a donut if you look at it through your vagina.
Cervical cancer usually takes years to develop. During this time, the cells in the cervix change and grow rapidly. The early changes that happen before it becomes full blown cancer (precancerous) are called “dysplasia” or “cervical intraepithelial neoplasia” (CIN). If these changes are found and treated, cervical cancer can be prevented. If not diagnosed and treated, cervical cancer can spread to other parts of the body and become deadly.
How common is cervical cancer?
Each year, about 13,000 people in the United States are diagnosed with cervical cancer. About 4,000 people die from it every year.
What causes cervical cancer?
Cervical cancer is caused by certain types of the human papillomavirus (HPV), the most common STD.
There are more than 200 kinds of HPV. Most of them aren’t harmful and go away on their own. But at least a dozen types of HPV can last and sometimes lead to cancer. Two in particular (types 16 and 18) lead to the majority of cervical cancer cases. These are called high-risk HPV.
Because HPV is such a common infection that usually goes away on its own, most people never know they have it. If you do find out that you have one of the high-risk types of HPV, don’t freak out — it doesn’t mean you have cancer. It means you have a type of HPV that can possibly lead to cancer in the future. That’s why catching it early is so important.
Who’s at risk for cervical cancer?
The biggest risk factor for cervical cancer is having one of the high-risk types of HPV. We don’t know why some people develop long-term HPV infections, precancerous cell changes, or cancer. But we do know that HPV is easily spread from sexual skin-to-skin contact with someone who has it.
HPV is spread by skin-to-skin contact with genitals, as well as oral, vaginal, and anal sex. That means it can be spread even if no one cums, and even if a penis doesn’t go inside the vagina/anus/mouth.
HPV is the most common STD, and most of the time it isn’t a big deal. It usually goes away on its own, and most people don’t even know that they ever had HPV. In fact, most people who have sex get HPV at some point in their lives.
Besides HPV, there are other things that increase your cervical cancer risk. These include:
A personal history of dysplasia of the cervix, vagina, or vulva
A family history of cervical cancer
Other infections such as chlamydia
Immune system problems such as HIV/AIDS that make it harder to fight infections like HPV
Having a mother who took a drug called diethylstilbestrol (DES) during pregnancy
Age is also a factor. The average age that cervical cancer is diagnosed is 48. It rarely affects those younger than 20.
All that being said, everyone who has a cervix is at risk for cervical cancer. So no matter who you sleep with or what your gender identity is, it’s important to take care of your cervical health.
Will cervical cancer affect my fertility?
Cervical cancer is treatable. If it’s found and treated early, there’s a good chance you’ll recover fully and not have any fertility problems.
Some cervical cancer treatments, though, can affect your fertility. If you get cervical cancer, your doctor will talk with you about the different treatments and their risks and side effects, including whether you’ll be able to get pregnant in the future.
What can I do to prevent cervical cancer?
Here are 4 things you can do to keep your cervix healthy.
Get regular check-ups. Pap tests and HPV tests look for abnormal changes to your cervix, so you can treat them before cancer develops. In general, you should get your first Pap test at age 21, and then every 3-5 years after that get screened with some combination of Pap/HPV tests. Your doctor or nurse can tell you which tests you need and how often you need them.
Get the HPV vaccine and encourage people in your life to do the same. There are 3 brands of the HPV vaccine (AKA cervical cancer vaccine). All of them protect against HPV types 16 and 18, the 2 kinds that cause most cervical cancer cases. HPV vaccines are given in a series of 3 shots over 6 months.
Use condoms or dental dams every time you have vaginal, anal, or oral sex. This helps lower the chances of spreading HPV during sex.
If you smoke, stop. If you have a high-risk type of HPV and you smoke, you’re more likely to get cervical cancer.
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