目的:宫颈上皮内瘤变(CIN)与可育性降低有关,定义为每个月经周期受孕的概率?
结论:总的来说,我们观察到CIN和可繁殖性之间没有有意义的关联,不管手术状态如何,尽管最近诊断为中度或重度CIN可能与诊断后2年的繁殖力略有降低有关。
背景:约15%的夫妇经历不孕症。很少有研究研究过CIN对生育力的影响,结果不一致。尚无研究调查可产性与病理学家报告的CIN诊断之间的关联,特别是关于特异性CIN诊断的新近度。
方法:这项前瞻性队列研究包括9586名试图怀孕的女性。这些妇女的入学时间为2007年6月1日至2020年2月3日。
方法:邀请女性完成基线问卷和双月随访问卷,为期12个月或直至怀孕。宫颈细胞学和活检的数据从国家病理学登记处(DNPR)检索,保存在丹麦检查的所有宫颈标本的记录。根据对CIN的最严重诊断对妇女进行分类:无病变,其他宫颈变化,mildCIN(CIN1),或中度/重度CIN(CIN2+)伴或不伴手术。为了研究CIN与可育性之间的关系,我们使用比例概率回归模型计算了可育率(FR)和95%置信区间(CI).我们在进入研究时调整了年龄,伴侣年龄,身体质量指数,吸烟状况,性交的时机,奇偶校验,教育,性伴侣的数量,和家庭收入。
结果:与无病变相比,CIN和可产性之间的关联的调整后的FR(95%CI)是:其他宫颈病变,0.97(0.91-1.04);CIN1,1.04(0.96-1.13);CIN2+无手术,1.00(0.82-1.22);CIN2+手术0.99(0.89-1.10)。最近诊断(<2年)CIN的FR(95%CI)对于其他宫颈病变为0.98(0.86-1.11);CIN1为1.13(0.99-1.29);与无病变组相比,CIN2未手术为0.89(0.62-1.26),CIN2未手术为0.91(0.75-1.10)。
结论:在分析中,我们调整了几个与女性相关的协变量.然而,我们几乎没有关于男性伴侣的信息,这可能导致无法测量的混杂,因为可生育性是一种基于夫妇的生育力测量。此外,aCIN诊断可能不是恒定的,因为它可能会自发地消退或进展;因此,我们有可能对一些女性进行了错误的分类,尤其是被归类为具有正常细胞或CIN1的女性。
结论:我们的研究结果为那些在接受aCIN诊断后关心未来生育能力的女性提供了重要的知识。
背景:本研究由丹麦癌症协会(R167-A11036-17-S2)资助。整个队列由美国国家儿童健康与人类发展研究所(R01-HD086742和R03-HD094117)资助。作者报告没有相互竞争的利益。
背景:不适用。
OBJECTIVE: Is cervical intraepithelial neoplasia (CIN) associated with reduced fecundability, defined as the probability of conceiving per menstrual cycle?
CONCLUSIONS: Overall, we observed no meaningful association between CIN and fecundability, regardless of surgical status, although a recent diagnosis of moderate or severe CIN might be associated with slightly reduced fecundability for 2 years after diagnosis.
BACKGROUND: About 15% of couples experience infertility. Few studies have examined the influence of CIN on fertility, and the results have been inconsistent. No
study has investigated the association between fecundability and pathologist-reported CIN diagnoses, particularly with respect to the recency of the specific CIN diagnoses.
METHODS: This prospective cohort
study included 9586 women trying to conceive. The women were enrolled from 1 June 2007 to 3 February 2020.
METHODS: Women were invited to complete a baseline questionnaire and bimonthly follow-up questionnaires for up to 12 months or until pregnancy occurred. Data on cervical cytologies and biopsies were retrieved from The National Pathology Registry (DNPR), which holds records of all cervical specimens examined in Denmark. Women were categorized based on their most severe diagnosis of CIN: no lesion, other cervical changes, mild CIN (CIN1), or moderate/severe CIN (CIN2+) with or without surgery. To investigate the association between CIN and fecundability, we computed fecundability ratios (FR) and 95% confidence intervals (CI) using a proportional probabilities regression model. We adjusted for age at
study entry, partner age, body mass index, smoking status, timing of intercourse, parity, education, number of sexual partners, and household income.
RESULTS: Compared with no lesion, the adjusted FRs (95% CI) for the association between CIN and fecundability were: other cervical lesions, 0.97 (0.91-1.04); CIN1, 1.04 (0.96-1.13); CIN2+ no surgery, 1.00 (0.82-1.22); and CIN2+ with surgery 0.99 (0.89-1.10). The FRs (95% CI) for a recent diagnosis (<2 years) of CIN were 0.98 (0.86-1.11) for other cervical lesions; 1.13 (0.99-1.29) for CIN1; 0.89 (0.62-1.26) for CIN2+ no surgery and 0.91 (0.75-1.10) for CIN2+ with surgery compared with the no lesion group.
CONCLUSIONS: In the analyses, we adjusted for several covariates related to the women. However, we had little information on the male partners which could lead to unmeasured confounding as fecundability is a couple-based measure of fertility. Furthermore, a CIN diagnosis may not be constant as it may regress or progress spontaneously; therefore, it is possible that we have misclassified some women, especially women categorized as having normal cells or CIN1.
CONCLUSIONS: Our results contribute important knowledge to women who are concerned about their future fertility after receiving a CIN diagnosis.
BACKGROUND: This
study was funded by The Danish Cancer Society (R167-A11036-17-S2). The overall cohorts were funded by the National Institute of Child Health and Human Development (R01-HD086742 and R03-HD094117). The authors report no competing interests.
BACKGROUND: N/A.