Pregnancy After A LEEP Procedure

One of the most common questions I receive from women with cervical dysplasia is how having a loop electrosurgical excision procedure (LEEP) may affect their ability to get pregnant and sustain a pregnancy.

LEEP is a method frequently used to treat high grade cervical dysplasia. Uncommonly, a LEEP may also be used to treat very early stage cervical cancer and may be used to diagnose the disease. During a LEEP procedure, a wire loop electrode with an electrical current is used to remove abnormal tissue from the cervix.

Risk Associated with Pregnancy After LEEP

Most women are concerned with how a LEEP will affect a pregnancy that follows the procedure. The risks associated with LEEP and pregnancy are:

• Cervical Incompetence.Cervical incompetence is a condition in which the cervix is unable to stay closed during a pregnancy. It can result in miscarriage and preterm labor. Stitches can be placed in the cervix to help keep it closed, and is called a cervical cerclage.
  
  
• Cervical Stenosis. Cervical stenosis is the tightening and narrowing of the cervix. This can cause the cervix difficulty in dilating during labor.
  
  
• Sterility. Although extremely rare, a LEEP may cause a woman to become sterile. However, research on LEEP and fertility is very limited.

A LEEP is a safe and highly effective treatment for cervical dysplasia. How a future pregnancy will be affected by a LEEP depends on how much cervical tissue has been removed by the LEEP and whether LEEP or other cervical surgery has been previously performed. Keep in mind that these complications affect only one to two percent of women who have a LEEP, but there is a slightly elevated risk of preterm labor. Most women do go on to have healthy, full term pregnancies.

Questions to Ask Your Doctor

There are several questions you should ask your doctor about LEEP even you plan on becoming pregnant:

• How do you think a LEEP will affect my pregnancy?
  
• Is a LEEP the only treatment option I have?
  
• How long will it take for my cervix to recover?
  
• When can I begin to have sex again?
  
• How long after a LEEP can I try to get pregnant?

During Pregnancy

Be sure to inform your doctor if you have had a LEEP at your first obstetric appointment. Providing your doctor with information, such as notes taken by the doctor during the LEEP and pathology reports, will help him or her determine the best way to manage the pregnancy.



Sources:

1. "Surgery." Cervical Cancer:Detailed Guide. 04 Aug 2006. American Cancer Society. 5 Jan 2007
   
2. "Treatment Options by Stage." Cervical Cancer:Detailed Guide. 04 Aug 2006. American Cancer Society. 7 Jan 2007
   
3. Kyrgiou M, Koliopoulos G, Martin-Hirsch P, Arbyn M, Prendiville W, Paraskevaidis E. "Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis." The Lancet 367(2006): 489-498.
   
4. Montz FJ. Impact of therapy for cervical intraepithelial neoplasia on fertility.. Am J Obstet Gynecol 1996; 175: 1129-1136.