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Cervical abnormalities: CIN3 and CGIN

Fertility and pregnancy

Many of the women we interviewed were concerned about the effects of LLETZ or cone biopsy on having children. Some said they would have liked more information about this before having treatment. Others said they had been given enough information and felt reassured that the doctors and nurses would help when the time came.

 

Bev and her husband Adam would have liked more information about pregnancy before her LLETZ. They...

Bev and her husband Adam would have liked more information about pregnancy before her LLETZ. They...

Age at interview: 33
Sex: Male
Age at diagnosis: 33
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Bev' I know from the leaflet that I signed for the consent form, the only real thing that they actually say is that is having a pre-term labour. But I know from some of the forum websites that I’ve read, a lot of people on there have said that they’ve had difficulty getting pregnant and it increases the risk of miscarriage, which is something I’ve not been told by the hospital and the doctors. So I don’t know where they’ve got that from, if that makes sense. Because nowhere have I actually been told that.

Husband' But again, though, this is one of those things that’s not in the information that you receive prior to the procedure. It’s information you receive as and after you have the procedure. And it’s difficult because, you know, how can a women make up her mind. Obviously yes granted the procedure has to be done. But if we’re talking about a woman of child bearing years, like my wife for example, you know is this now going to put added thought into the back of her mind of pregnancy, do we run the risk of this being early-term, this, that and the other?

Again there’s no percentage rates of this is how many women suffer premature births, or miscarriage, if miscarriage is a side effect of it. You know. Again this is only information that we’ve, that my wife got from the internet. You know, this hasn’t come from the doctors, so as far as I’m concerned this is just pure hearsay. This might have happened to one woman, and what’s happened is that this is now you know, blown out of all proportion.

Treatment for CIN / CGIN should not affect a woman’s ability to get pregnant in the future. Women who have had a cone biopsy or LLETZ are at slightly greater risk of miscarriage and premature labour, before 37 weeks, because of their weakened cervix. A cone biopsy poses a greater risk than LLETZ treatment.

The cervix is really a muscle that keeps the entrance to the womb closed unless a woman is in labour. In some women who have had a cone biopsy, there is a risk that the cervix may start to open too soon because of the weight of the growing baby. Serious problems can usually be prevented. If the doctor thinks a woman’s cervix may start to open too soon, she can have a stitch put around it to hold it shut. This is called a purse string suture. The stitch is cut before the woman goes into labour, usually at about week 37 of pregnancy. The cervix can then open normally for the baby to come out.

 

A doctor explains that, although there is a small risk of miscarriage and premature labour after treatment for CIN / CGIN, most women go on to have successful pregnancies.

A doctor explains that, although there is a small risk of miscarriage and premature labour after treatment for CIN / CGIN, most women go on to have successful pregnancies.

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A loop excision for CIN doesn’t affect the ability to get pregnant. It can slightly increase the risk of miscarriage, and it can slightly increase the risk of premature labour.

A cone biopsy also does this but more. It’s more likely to than a loop excision. I think the important thing to recognise is that it is, I think the important thing for women to recognise is that these abnormalities need to be treated. The vast majority of women go on to have successful pregnancies after this treatment. And I think it’s just important to let your obstetrician know when you are pregnant that you’ve been treated, so they can monitor the cervix and intervene if necessary.

 

Gillian felt angry that she hadn’t been told about the risks of treatment on pregnancy before...

Gillian felt angry that she hadn’t been told about the risks of treatment on pregnancy before...

Age at interview: 30
Sex: Female
Age at diagnosis: 27
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Well there was things I found out, I was clueless to be honest. And I think it was more the things he [second consultant] was telling me, the more I spoke to him there was things that I didn’t realise that the colposcopy had done. So he said to me whenever I get pregnant I may well have to get a stitch put in because your cervix is the part of your body when you’re pregnant that is the muscle I think that holds, I think is that right? That holds your baby up.

If your cervix has been compromised, the integrity of it, in terms of the size of it or the strength of it, I think you may need to get stitches before you are pregnant to ensure that you don’t miscarry.

So I’d never heard that before. And that made me quite angry because I thought, what he’d said to me was, if you had quite a significant amount of your, you can take little bits of your cervix away first to determine whether you need to take away more. And I think because the lady who treated me initially had taken away more to err on the side of caution, at the initial colposcopy, that wasn’t necessarily needed.

One woman was particularly worried because she was planning to start IVF treatment when the LLETZ wound had healed. Her doctor reassured her that LLETZ would not interfere with the IVF treatment. Anna, who’d had a miscarriage before, was concerned about her risk of having another miscarriage because of treatment.

 

Anna was worried about her chances of having another miscarriage, especially as she’d had LLETZ...

Anna was worried about her chances of having another miscarriage, especially as she’d had LLETZ...

Age at interview: 29
Sex: Female
Age at diagnosis: 28
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He [consultant] said obviously it could mean that I was more likely to have a miscarriage, but he couldn’t say either way really. I was more pleased obviously to have it removed, that was my main concern really. That had to be out. I think because I’d had a previous miscarriage it frightened me a bit more because it’s a scary thing to go through at any time and I just thought ‘could I go through that again’?

I think they were the main important questions and, in the end, I did have to go and see my doctors and speak to them about it, because it was, to my GP because it was worrying me.

And did you feel reassured afterwards?

I did. She said the chances are very slim, and as it was such a small amount that was removed. But obviously she understood my concerns.

Some women were trying to conceive when they were diagnosed with CIN3 and wondered how long they’d have to wait before they could try again.

 

A doctor explains that women can try for a baby after the treatment has been completely...

A doctor explains that women can try for a baby after the treatment has been completely...

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Normally after the treatment you get a bit of bleeding, which can last for three weeks to a month. We normally say no tampons and no sex until the bleeding has completely settled down. And then after that, as long as the treatment has been successful, there’s no reason not to start trying for a pregnancy immediately.

 

Maria was advised to wait until she’d had a clear result after her follow-up appointment before...

Maria was advised to wait until she’d had a clear result after her follow-up appointment before...

Age at interview: 34
Sex: Female
Age at diagnosis: 33
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He [consultant] said like, “No exercise for a month, no sexual intercourse for six weeks.” And then, well, no trying for a baby for four months, which was the hardest to accept really because, you know, as I said, you feel like time is passing by and it’s, you feel it’s a bit unfair.

But I mean we’re almost there, so October is coming up soon. So hopefully I will, after that I can get the all clear. Sometimes it’s hard to really understand why, so you think, “Oh.”

Would you have liked more information about that, you know trying for a baby afterwards?

Yeah.

Or anything to do with, if you’ve had CIN3 or CGIN?

Yeah. I mean the doctor said that there shouldn’t be any impact on fertility apart from the cervix maybe being weak, but they can stitch it. But sometimes you think, “Oh is that the whole truth? Or is there like an exception that I could fall into?” You know, your mind goes into overdrive I guess.

But, I mean I guess the best thing is to be positive and trust that you’re not going to be the one percent, or, you know 0.5 percent or whatever that is the real exception. And, I mean at first I was really annoyed and thought, “Oh this is so unfair.”

But now that I’m more relaxed I’m thinking how I’ve been really lucky because, had I got pregnant or something, and then maybe I wouldn’t have been to see a doctor for two years, and then God knows what would have happened. So, I guess it’s good to relax as well, which is not easy but it’s good to take a step back and actually realise you’re lucky rather than unlucky.

Some of the women we spoke to talked about having children after treatment for CIN3.

 

Genevieve got pregnant shortly after trying for a baby. She was well looked after by her doctors...

Genevieve got pregnant shortly after trying for a baby. She was well looked after by her doctors...

Age at interview: 41
Sex: Female
Age at diagnosis: 33
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I had a test then just before Christmas. The doctor said everything was clear and looked fine, but he obviously took cells and they were all checked, and I got the results in January. Started for a baby immediately and got pregnant in the March. So literally about two months later we were pregnant. So I did have some concern about my cervix because they’d taken quite a piece of my cervix away, that I might have an incompetent cervix.

But I was referred by the original doctor who did the treatments, to a good obstetrician who was aware of my treatment, in the same hospital, and he kept a very close eye on me. And I had a very normal pregnancy all the way through, and went through and delivered naturally 42 weeks later. And now have a seven year old who goes to school and two years later we had our second daughter. So I’ve got a seven and five year old. I continue to go and see the original gynaecologist and I have regular, annual smear tests.

 

Lizzie was reassured by her doctor that having a baby after LLETZ treatment would be fine. She...

Lizzie was reassured by her doctor that having a baby after LLETZ treatment would be fine. She...

Age at interview: 39
Sex: Female
Age at diagnosis: 36
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The other thing as well was having my mind put to rest about having other children as well. Because obviously having a portion of your cervix removed, you know, I was worried about the possibility of having other children. We hadn’t planned any, but we’ve had another one anyway. And he was like, “No, it’s fine, you know. The only one that’s likely to cause a problem is the cone biopsy, this one is fine because it’s just slicing off a tip off the nose.” He explained it all very easily so I understood exactly what was going on.

I wasn’t sure how it would affect my cervix and everything else. But he said, “Oh no, not a problem.” But obviously each case is different. But he sort of stated that what he was doing was not problematic. But even if I’d had the worst sort of option, it would still have been possible, you know. It would just have been a case of managing it, that nothing was impossible if you like.

Jane said she miscarried after having laser treatment and wondered at first if the laser treatment had been the cause. This is unlikely as there are many reasons why a woman may have a miscarriage. She later went on to have two daughters.

 

There was no specific reason why Jane might have had a miscarriage. She later got pregnant again...

There was no specific reason why Jane might have had a miscarriage. She later got pregnant again...

Age at interview: 50
Sex: Female
Age at diagnosis: 30
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I had a wonderful wedding, honeymoon and everything, then got pregnant. And then it just all went wrong. And I straight away thought it was linked to the laser therapy or that the cancerous cells had come back and they’d somehow killed the baby. I know it can’t possibly happen, but you have these crazy notions don’t you.

Anyway, so that was quite horrible as well and, because where I was at the time I went to hospital, and some of the nurses were quite nice and supportive but basically the procedure is called D & C. Can’t remember what it stands for. Basically they scrape out the lining of your womb and they called it, “To remove the products of conception.” Which I think is a very horrible way of describing it and they should think of a better way.

The miscarriage was just a miscarriage. Nobody ever found out why not. Nobody tried to find out why not because very soon afterwards I got pregnant and I went to full term. It wasn’t a completely straightforward birth with my other daughter but she had a couple of weeks in the special care baby unit and then she was fine. And she’s absolutely fine now.

And a year later you were pregnant again?

And a year later I was pregnant again. Yeah, there’s 15 months between my two daughters. That wasn’t a totally normal birth either, but she came out in the end with the forceps and she’s absolutely fine now as well.

Anne Marie was worried about having another child after she had a haemorrhage following her cone biopsy.

 

The midwife reassured Anne Marie that the chances of her having a problem were low. She delivered...

The midwife reassured Anne Marie that the chances of her having a problem were low. She delivered...

Age at interview: 44
Sex: Female
Age at diagnosis: 29
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It did affect me in as much as I was scared to have sex. I was scared to have another baby. I’ve got a big age gap between my children, me and my husband have been together a long time but we’ve got a seven year age gap because of this. And that was down to me.

And that…

I was terrified. I was imagining all sorts because I wasn’t worried about conceiving because I’d asked that question and they said you should be fine. I was worried about the actual physicality of giving birth, and what would happen to my cervix, and how would it all happen and work and what would happen if it all went wrong.

So, but you did get pregnant?

I did yeah.

And how did everything go? Did you have any concerns throughout, or were you fine?

I was okay for most of the time, until it was getting nearer the time, nearer the 40 weeks, and I thought well, you know, that baby’s in there. And he’s got to come out, and as it got closer and closer to the date I was really worried and I broached the subject with one of the midwives eventually.

Had they known at all that you’d had this experience before? The CIN 3?

Yeah, they had my records, but I think there’s not enough continuity in... There wasn’t then. I don’t know if there is now. I know they try and give you the same midwife wherever possible, but it doesn’t always work out. I think if there’d have been a bit more continuity, they’d have known.

But I did have [son’s name], my baby in the same hospital where I had the operation, so all the records were there. And I can’t say for sure that they knew, but eventually I did, when I broached the subject, she said, “Oh yeah, you’ll all be fine. It’ll all be fine.” No problem. And if there are any problems, you know, we’ll deal with it.

So that’s quite reassuring?

Yeah. Because she said, “all we do is,” she goes, “you know loads of people who’ve had caesareans, and if there’s a problem you’ll just have to have a caesarean if that’s okay with you.” And I said, “Yeah, well that’s fine.” And that was really the end of it.

So you had your baby, everything was fine? Did you have a caesarean, or…?

No, it was all spontaneous, natural birth.


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Last reviewed July 2017.
Last updated May 2014.
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