A prospective study of treatments for cervical intraepithelial neoplasia and fecundability

Wise, Lauren A.; Willis, Sydney K; Perkins, Rebecca B.; Wesselink, Amelia K.; Klann, Alexandra; Crowe, Holly M; Hahn, Kristen A.; Mikkelsen, Ellen M; Hatch, Elizabeth E.

doi:10.1016/j.ajog.2019.12.017

Cited by 9 publications

(10 citation statements)

References 46 publications

(69 reference statements)

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“…The results of this study suggest that female patients with CIN or early cervical cancer history have lower ovarian reserve, reduced pregnancy rate, and decreased CLBR, compared with age-matched women undergoing IVF/ICSI. Although the infertility rate and IVF delivery proportion of patients with ECL history were not increased according to previous studies ( 7 , 8 ), it appears that those infertile patients do not have an optimal outcome in seeking ART treatment. Moreover, the time interval between ECL diagnosis/treatment and ART cycle start is seemingly associated with the pregnancy rate and LBR.…”

Section: Discussionmentioning

confidence: 66%

“…The fecundability and obstetric outcomes of the patients with a history of early cervical lesions (ECL), including CIN and early invasive cancer, were analyzed previously. A case-control study showed a 2-fold increase in risk of infertility for women after CIN treatments compared with untreated women ( 6 ), while other studies involving larger samples demonstrated no evident adverse effects of CIN history and treatments on fertility ( 7 , 8 ). As for early invasive cervical cancer, previous studies mainly focused on obstetric outcomes following different-type surgeries, such as abdominal, vaginal, or robot-assisted radical trachelectomy, aiming to prove the feasibility and safety of surgeries ( 9 – 12 ).…”

Section: Introductionmentioning

confidence: 96%

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Early Cervical Lesions Affecting Ovarian Reserve and Reproductive Outcomes of Females in Assisted Reproductive Cycles

Yang

Wang

et al. 2022

Front. Oncol.

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To estimate the effects of early cervical lesions (ECL) on female reproductive function and IVF/ICSI cycle outcomes, a retrospective cohort study involving 111 infertile women from 2014 to 2019 was performed. Thirty-seven women with a history of ECL and seventy-four controls, undergoing IVF/ICSI cycles, were included in the ECL group and comparison group respectively. Demographic characteristics, ovarian reserve, and IVF/ICSI cycle outcomes of both groups were collected. Basal serum FSH level, AMH level, AFC, number of oocytes retrieved and matured, normal fertilization rate, embryo available rate, blastocyst formation rate, implantation rate, pregnancy rate, and cumulative live birth rate (CLBR) were assessed and compared. We observed that while both groups were similar concerning baseline features, significantly more women in the ECL group were diagnosed as poor ovarian response (POR), compared with those in the comparison group (27.0% vs. 10.8%, P=0.003). The pregnancy rate and LBR for a complete cycle were both significantly lower in the ECL group (38.5% vs. 58.8%, P=0.021; 28.9% vs. 48.2%, P=0.025, respectively). The conservative and optimal CLBRs for up to four complete cycles in the ECL group were also lower than those in the comparison group (40.5% vs. 55.4%, P=0.140; 45.9% vs. 67.6%, P=0.028). Longer time intervals (over one year) between ECL diagnosis/treatment and assisted reproductive technology (ART) cycle start negatively affected the pregnancy rate and LBR. In conclusion, female patients with ECL history seemingly have a lower ovarian reserve, reduced pregnancy rate, and decreased live birth rate (LBR), compared with age-matched women undergoing IVF/ICSI.

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Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 96%

Early Cervical Lesions Affecting Ovarian Reserve and Reproductive Outcomes of Females in Assisted Reproductive Cycles

Yang

Wang

et al. 2022

Front. Oncol.

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“…In general, when CIN is veri ed, cervical LSIL is considered an acute HPV infection and often regresses without therapies, many clinicians take observation instead of immediate excision. Although cervical HSIL might reverse too, clinicians generally take an excision biopsy: knife cone biopsy, laser conization, cryotherapy, laser ablation or loop electrosurgical excisional procedure(LEEP) to identify or prevent carcinogenesis [28,29]. In view of different treatments, we de ned HSIL + as a pathological result in order to compare the difference between LSIL and HSIL+.…”

Section: Discussionmentioning

confidence: 99%

The risk of cervical lesions caused by HPV16/18 combined with other high-risk and low-risk HPV types: A retrospective study

Wang

Zhu

et al. 2022

Preprint

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Background HPV16 and 18 are the most common high-risk human papillomavirus (HPV) types causing cervical lesions. Women with HPV16 and/or 18(HPV16/18) infections are the main targets for cervical screening. But the HPV16/18 infection status is complex, and clarifying the risk of different infection patterns for cervical lesions is essential for subsequent management options. Our study aimed to assess the risk of HPV16 or 18 combined with other high-risk(HR) and/or low-risk(LR) HPV types for cervical lesions and their clinical characteristics. Methods In this retrospective study, we analyzed the clinical data of 3,217 patients with HPV16/18 infection.We divided HPV16 or HPV18 multiple infections into 8 patterns: HPV16 + HR, HPV16 + LR, HPV16 + HR + LR, HPV18 + HR, HPV18 + LR, HPV18 + HR + LR, HPV16 + 18 and HPV16 + 18 + other-HPV. The analysis of data was performed by Chi-square test and multinational logistic regression. P < 0.05 was considered statistically significant. Results Among the HPV16/18 positive population, multiple infections accounted for 41.5% (1336/3217), and multiple infections were mainly associated with LSIL while single infection was more associated with HSIL+. And the risk of cervical lesions varied with different infection patterns. After adjusting co-factors, multiple logistic regression showed that compared with single HPV16 or 18 infection, HPV16 + HR and HPV18 + HR had a higher risk for LSIL(OR = 1.659, 95%=1.278–2.153; OR = 1.744,95%=1.046–2.907) while HPV16 + LR had a lower risk for HSIL+(OR = 0.477, 95%CI = 0.277–0.822). Conclusion Single HPV16 or 18 infection is more relevant to HSIL + with respect to multiple infections. Multiple infections may be transient that mainly lead to LSIL. Different infection patterns of multiple infections have different risks for cervical lesions, HPV16 or 18 combined with other HR-HPV are associated with a higher risk of LSIL, but HPV16 combined with LR-HPV decreases the risk of HSIL+. We propose that there is antagonistic relationship between HPV16 and some LR-HPV types.

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“…Treatment of cervical precancerous lesions is performed with the aim of preventing their development into invasive cancer [ 4 ]. CIN1 includes low-grade lesions that regress spontaneously within 2 years in more than 60% of cases and are therefore treated conservatively [ 4 , 5 ]. CIN2 and CIN3 are considered high-risk lesions.…”

Section: Cervical Intraepithelial Neoplasia Grade 2 (Cin2) and Its Cu...mentioning

confidence: 99%

“…CIN2 and CIN3 are considered high-risk lesions. Although they also have the ability to spontaneous regress, they are usually treated with excisional or ablative procedures [ 5 ]. In developed countries, the annual incidence of CIN2/3 is 1.5/1000 women, and the incidence is the highest in the age group between 25 and 29 years old [ 6 ].…”

Section: Cervical Intraepithelial Neoplasia Grade 2 (Cin2) and Its Cu...mentioning

confidence: 99%

The Role of Methylation of Host and/or Human Papillomavirus (HPV) DNA in Management of Cervical Intraepithelial Neoplasia Grade 2 (CIN2) Lesions

Dovnik

Poljak

2023

IJMS

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Cervical intraepithelial neoplasia grade 2 (CIN2) is an intermediate stage between CIN 1, which is a low-grade lesion, and CIN3, which is the immediate precursor of cervical cancer (CC). Traditionally, CIN2 was regarded as a high-grade lesion and was treated with conization or ablative methods. In recent years, there has been a shift in the management of younger patients, who are now more often being managed conservatively due to frequent spontaneous CIN2 regression and possible adverse effects of treatment on future pregnancies. Because the risk of progression to CC still exists with conservative management, a personalized approach is needed to identify patients with a higher probability of progression. In this regard, research has focused on the role of host and human papillomavirus (HPV) gene methylation. This systematic review summarizes the current knowledge regarding conservative CIN2 management focusing on the main methylation markers and its implementation in conservative CIN2 management, and it describes major ongoing longitudinal studies on the subject. The review showed that DNA methylation is an accurate predictor of disease progression and a valid triage tool for HPV-positive women, with CIN2 performing better than triage cytology. Because virtually all CCs are methylation-positive, methylation-negative women at baseline have an extremely low risk of CC.

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A prospective study of treatments for cervical intraepithelial neoplasia and fecundability

Cited by 9 publications

References 46 publications

Early Cervical Lesions Affecting Ovarian Reserve and Reproductive Outcomes of Females in Assisted Reproductive Cycles

Early Cervical Lesions Affecting Ovarian Reserve and Reproductive Outcomes of Females in Assisted Reproductive Cycles

The risk of cervical lesions caused by HPV16/18 combined with other high-risk and low-risk HPV types: A retrospective study

The Role of Methylation of Host and/or Human Papillomavirus (HPV) DNA in Management of Cervical Intraepithelial Neoplasia Grade 2 (CIN2) Lesions

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