Does a LEEP procedure or a cold-knife cone biopsy procedure affect fertility?

--Karen

Both LEEP (loop electrosurgical excision procedure) and cold-knife conization are surgical procedures to remove a portion of the cervix to treat precancerous changes. While the success rate of these procedures is quite high, complications are not uncommon. Cervical stenosis (a scarring that narrows or closes the cervical opening) may impair the ability of sperm to enter the cervical canal on their journey to the uterus. LEEP, if not done properly, may result in removal of too large a portion of the cervix. This may weaken the cervix and cause cervical incompetence (dilation without contractions before the pregnancy is complete).

Cervical stenosis may be treatable by performing a D&C to dilate the cervix under anesthesia. Frequently, though, it will scar shut in a relatively short period. In most cases, a tiny catheter can be passed into the cervix to perform an intrauterine insemination just before ovulation, and pregnancy can be achieved this way.

Cervical incompetence, if detected before problems arise in a pregnancy, can be addressed by a relatively simple surgical procedure in which a suture (stitch) is placed to block the opening and prevent the cervix from dilating prematurely. If too much of the cervix has been removed, however, this procedure may not be possible, and successful pregnancy could be difficult.