Dear Professor Winston
What’s your take on problems getting pregnant with pre-cancerous cells treatment loop? My fertility problem has come back unexplained. I’m not allowed IVF due to my husband having a child already from a previous relationship. I have expressed my concern about the treatment but they won’t entertain it. Also I do have a small cyst and a small patch of endometriosis on my left ovary which they have said is nothing to worry about. M

Reply…

Dear M,

I think your concerns are reasonable but I do not think should be a major worry. My impression, though there are not great statistics on this, that people with an abnormal cervix may occasionally be more likely to be infertile (though, of course, IVF can bypass this). Its a very grey area because there are a number of partly unrelated reasons why this is so. It is also true that the old-fashioned cone biopsy undoubtedly left some women with the experience of difficulty in conception. There are varying figures on whether treatment with the loop carries a similar risk. Many practitioners who use it certainly claim that it is harmless and that fertility is unimpaired. I am less convinced and do have a slight concern that it could contribute to infertility in some, probably few, women.

But of course, if you have cancerous cells your choices are limited and you may be much better to get effective treatment. Cervical cancer is a bad disease and the treatment not always successful; the treatment you are being offered makes any chance of it developing much less likely. You could opt to have repeat smears in a few months time, of course, but shouldn’t leave it too long. The other thing I would say is that if you haven’t had this done already, I would definitely suggest you consider having an hysterosalpingogram (x-rays of the uterus) and perhaps if you haven’t yet had this and can persuade them to do it, a laparoscopy. People like you do have a high possibility of some tubal changes or adhesions and this knowledge may help your decision about the treatment to your cervix.

Best wishes
Robert Winston

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