Cervical intraepithelial neoplasia: Reproductive effects of treatment
- Maija Jakobsson, MD, PhD
Maija Jakobsson, MD, PhD
- Helsinki University Hospital
- Errol R Norwitz, MD, PhD, MBA
Errol R Norwitz, MD, PhD, MBA
- Professor and Chair
- Department of Obstetrics and Gynecology
- Tufts Medical Center and Tufts University School of Medicine
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Vincenzo Berghella, MD
Vincenzo Berghella, MD
- Section Editor — Obstetrics
- Director, Maternal-Fetal Medicine
- Professor, Obstetrics and Gynecology
- Thomas Jefferson University
Cervical intraepithelial neoplasia (CIN) is a precursor to cervical cancer that is managed with either surveillance (cervical cytology and colposcopy) or treatment. Treatments for CIN include ablative or excisional cervical procedures. These treatments are often performed in reproductive-age women and may impact future fertility and pregnancy outcome. Awareness of reproductive risks associated with CIN treatment allows clinicians and patients to choose the optimal treatment method and to address subsequent reproductive issues.
CIN is also referred to as cervical dysplasia or cervical squamous intraepithelial lesions (CSIL). (See "Cervical intraepithelial neoplasia: Terminology, incidence, pathogenesis, and prevention", section on 'Terminology'.)
Reproductive effects of CIN treatment are reviewed here. General principles of CIN management and techniques for CIN treatment are discussed separately. (See "Cervical intraepithelial neoplasia: Management of low-grade and high-grade lesions" and "Cervical intraepithelial neoplasia: Procedures for cervical conization" and "Cervical intraepithelial neoplasia: Ablative therapies".)
EXCISION VERSUS ABLATION
There are two main categories of cervical intraepithelial neoplasia (CIN) treatment, excision and ablation. In excisional procedures (also referred to as conization; procedures include cold knife conization, loop electrosurgical excision procedure [LEEP], and laser conization), a segment of the cervix is removed and examined histologically. In ablative procedures (techniques include cryotherapy, laser, cold coagulation, diathermy), the tissue is destroyed, but remains in place; no histologic confirmation of the diagnosis is performed.
LEEP and cold knife conization are the most commonly used excisional methods; cryotherapy is the most commonly used ablative therapy. Laser conization and ablation are used less frequently, since they require expensive and bulky equipment. Diathermy and cold coagulation ablation are rarely used.
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- EXCISION VERSUS ABLATION
- MECHANISMS OF REPRODUCTIVE EFFECTS
- CERVICAL STENOSIS
- SECOND TRIMESTER PREGNANCY LOSS
- PRETERM PREMATURE RUPTURE OF MEMBRANES
- PRETERM DELIVERY AND PERINATAL MORTALITY
- Risks of individual treatment methods
- Modifying factors
- - Depth of excision
- - Number of procedures
- - Short interval from treatment to pregnancy
- - Multiple gestation
- PERFORMANCE OF PROCEDURES DURING PREGNANCY
- OBSTETRIC MANAGEMENT IN SUBSEQUENT PREGNANCIES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS