Impact of Abnormal Smears and Loop Biopsy on Fertility and Pregnancy

thank you for joining me my name is anil taylor i'm a consultant gynecologist and i

practice in the uk in this short video i want to talk about whether having abnormal smears or having

a corposcopy examination or whether having treatment such as loop biopsy of the

cervix whether these have the potential to affect future fertility or

the potential to affect future pregnancies and how they would behave

so i have already created quite a few other videos short videos on specific topics

such as what abnormal smears mean what a corpostomy test involves how are

smears abnormal smears generally treated what does a loop biopsy actually involve all these

are already uploaded and please search them out because they will help you

understand what i say in this video and in more context so

um smears do smears themselves are having abnormal

smears could can they affect future fertility now abnormal smears are

obviously in the uk graded into four abnormalities the borderline mild moderate severe and the borderline and

the mild are the low grade and the moderate and the severe are the high grade

now um smears abnormal smears in themselves

do not affect fertility nor do they affect

how future pregnancies may behave what i mean by that is whether there is an increased risk of miscarriages or

preterm labor so generally speaking having an abnormal smear will not affect fertility or the

way future pregnancies will behave now let's consider

the the communist reason for developing abnormal smears so that

is of course the hpv virus and it's a very very common virus uh

a majority of women by the age of 25 have acquired it um and most women the immune system will get rid of it

and the the the woman will not even develop any any abnormal cell changes in some women the the hpv

virus persists and that can then cause some cell changes on the cervix but what we do know is that hpv virus

itself does not affect fertility nor does it affect how

future pregnancies would behave however

if one considers when

the hpv was first acquired by any woman if any other infections were picked up

the main one here being chlamydia then that can affect fertility because

what we know about chlamydia is that it's it's very common and it can affect the tubes and cause blockage of the

tubes now if it causes blockage of the tubes then that will mean that the sperm

the sperm can't meet the egg and therefore fertilization can't happen and that that is the

mechanism behind the infertility so the hpv virus itself does not cause

these problems but if there were any other infections picked up at the same time such as chlamydia then they

certainly can cause infertility um what about the coposcopy test itself does that um have any detrimental effect

and the answer to that is no it is perfectly safe it's a it's a test that takes about five minutes um yes during

the examination the uh the cervix will be sort of cleaned with mild vinegar solution

acetic acid that would be to clear away the the mucus but it also show up the the

abnormal pre-cancerous areas but that in itself does not

increase the chance of infertility and indeed even during pregnancy

we can safely perform uh corposcopic examination and it does not cause any problems with the fetus

so colposcopy examination is safe and it does not cause problems um with the pregnancy

what about loop biopsy so the loop biopsy is a is a procedure that is very commonly performed uh especially in the

uk to treat high-grade abnormal smears so in a loop biopsy a little bit of local anesthetic

is put into the cervix and using a very thin wire a loop of wire

and using a special electric current passed through that wire

we are able to scoop away a tiny portion of the cervix the portion that contains the the abnormal uh

cells um and leaving behind a tiny crater now most gynecologists in this country would

when they do the loop biopsy would would carry out a very shallow because it's only the superficial surface area that

that needs to be scooped away and what research is has shown is that when it is kept shallow meaning usually

less than 10 millimeters in depth um then it doesn't cause any significant

problems uh with me uh with those in pregnancy such as miscarriages and it certainly does not affect

fertility so having a loop biopsy does not affect future fertility meaning your ability to fall pregnant is not affected

so the the debate is whether having a loop biopsy

affects how pregnancies would behave now what research is showing is that early miscarriages meaning miscarriage

in the first 12 weeks they are not affected by having a loop biopsy

how about the the middle of pregnancy meaning what we call the second trimester now

research is seeming to suggest that having a loop biopsy can increase the risk of

um having what we call late miscarriages however

let's put this into context late miscarriages are in themselves rare so most miscarriages if they are going

to happen usually happen in the first trimester they are very common

and they are not affected by loop biopsy once the pregnancy establishes itself and you enter the second trimester

miscarriages at that point are not common and

so um estimate

probably about half a percent of pregnancies um would end up with a miscarriage in the

in the second trimester and what research seems to suggest is that

perhaps that is increased by two or three times so meaning say about 1.5 compared to 0.5

so that risk of miscarriage is still very low and furthermore

the the research is seeming to suggest that it's when when the when the the loop biopsy

was fairly chunky meaning failing deep that's when it seems to cause a problem so most women who have loop biopsies

will not have any problems with mis excess miscarriages in their pregnancies

what about pre-term labor again research is seeming to suggest that

women who have women who have loop biopsies may may be at a slightly

increased risk of having pre-term deliveries

there is also some debate as to some women in whom there is excessive

scarring in the cervix whether that in itself delays the progress of early labor because of the

the scarring in the cervix so these are these are some of the things that is debated

but on the whole it should not stop you from having a loop biopsy

if if that is what is required to treat your uh to treat your uh abdominal sphere um

now in the uh uh old days before lubopsi's uh became common

we used to do a lot of uh much more aggressive biopsies called knife gone boxes now they are rarely

performed in the uk these days and yes they as i said were much more aggressive and

certainly did cause problems in pregnancies didn't necessarily affect fertility but

certainly did cause problems in pregnancies but that is now rarely performed

in the uk now because of this

risk of miscarriage with loop biopsy you will understand why some women who present with low grade

smears are not necessarily treated it's only the high grade

smear abnormalities that are treated with lube biopsies so the low grade smear abnormalities are usually left

alone and monitored because they there is a there's a good chance that in those women the immune system will get rid of

the problem by itself and and that is the reason why uh we try not to interfere in women with low grade

abnormalities i know it can be frustrating for some women to keep coming to the colposcopy clinic

to have themselves checked out and and some of them just wonder well why can't they just have the treatment and just

get rid of it the reason that we try not to interfere with the cervix is because

it does have slight effect in terms of future pregnancies so

um that is all i'm going to say about on this topic i have created quite a lot of other

videos which have been uploaded please search them out there are many on similar topics but also on other topics

as well so by all means search them out and

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thank you for watching and until next time stay safe thank you bye