We read, with interest, the article by Spracklen et al. This article addresses an important and growing issue, as increasing numbers of women are being diagnosed and treated for high-grade cervical intraepithelial neoplasia (CIN). As we are diagnosing and treating younger patients and women are waiting longer to start a family, this issue will become more prevalent within western society. Nevertheless, we believe that no one would advocate leaving a potentially cancerous lesion in situ to preserve fertility, but when discussing with women their treatment for CIN, it may be necessary to advise them of the potential impact on their fertility.
In our opinion, there are several shortcomings to this article. The study design appears to use old data (2002–2005) and does not take into account the recent developments in our understanding of the interaction between HPV and the development of CIN. The article does not comment on current US guidelines on cervical screening. A further aspect of the study design that we believe could be improved upon is that all the data regarding CIN treatment were obtained during a telephone interview with no confirmation or review of the notes.
Although we understand that the inability to conceive within 12 months is the generally accepted definition of subfertility, we speculate that there was a possible bias, as the authors did not describe whether there was an average time of delayed conception within the treatment group and the reasons for subfertility.
Overall, this paper opens up an important discussion into the increasing numbers of women treated for CIN. It does not answer all the questions posed, but acts as a starting point for further discussion and research.