The Human Papillomavirus (HPV) is a highly common viral infection, often clearing on its own without causing symptoms. It is the most frequently reported sexually transmitted infection in the United States, with a majority of sexually active individuals contracting it. Despite its prevalence, the virus itself generally does not prevent pregnancy or lower fertility rates. Concerns about HPV and conception are usually related to the complications or treatments associated with the virus, rather than the infection itself.
Does HPV Affect the Ability to Conceive
HPV is a localized infection affecting the skin and mucous membranes. It does not typically interfere with the systemic processes required for conception, such as ovulation, fertilization, or implantation. Unlike some other sexually transmitted infections that cause pelvic inflammatory disease (PID) or blockage of the fallopian tubes, HPV does not cause structural damage to the reproductive organs. Therefore, an HPV diagnosis does not usually mean an individual will have difficulty becoming pregnant.
High-risk strains of HPV cause abnormal cell growth, or dysplasia, in the cervix, but this cellular change does not create a physical barrier to sperm or prevent conception. However, some studies suggest that HPV may affect the reproductive process in more subtle ways. The virus has been linked to decreased sperm motility in men, as it can bind to the head of the sperm cell. It may also increase the risk of early pregnancy loss in some cases.
The primary concern regarding HPV and fertility stems from the treatment for high-grade cervical changes, not the virus itself. Procedures like the Loop Electrosurgical Excision Procedure (LEEP) or cone biopsy remove a section of the cervix to eliminate precancerous cells. In rare instances, removing a large amount of tissue can cause scarring or narrowing of the cervical opening (cervical stenosis), which could theoretically impede sperm movement.
More commonly, LEEP or cone biopsy can affect the quality of cervical mucus or cause minor cervical incompetence (a weakening of the cervix). This is generally not a cause of infertility, but it is associated with a slightly increased risk of preterm birth in subsequent pregnancies. This risk is higher if a significant amount of tissue was removed or if multiple procedures were performed. Most individuals who have had these procedures go on to have successful pregnancies, and any impact on fertility is rare.
Potential Effects of HPV on Pregnancy and Delivery
Hormonal and immunological changes during pregnancy can sometimes alter the behavior of HPV. Individuals with low-risk HPV types may notice that existing genital warts grow larger, multiply, or bleed more easily due to increased blood flow and changes in vaginal discharge. In most cases, these warts do not cause complications and may shrink or disappear spontaneously after delivery.
A primary concern is the risk of vertical transmission, which is the passing of the virus from the birthing parent to the baby. Transmission can occur during vaginal delivery through direct contact with active lesions, though this is considered unlikely. Most babies who contract the virus clear it naturally without long-term problems.
In extremely rare cases, vertical transmission can lead to Juvenile-Onset Recurrent Respiratory Papillomatosis (JORRP). This serious condition involves the growth of warts on the baby’s vocal cords or in the airway, often requiring repeated laser surgery to prevent breathing obstruction. Despite this rare risk, a cesarean delivery is not routinely recommended for HPV infection or genital warts, as it has not been shown to prevent vertical transmission. A C-section is typically only considered if very large warts are physically blocking the birth canal or causing significant bleeding.
Some research suggests an association between maternal HPV infection and adverse outcomes like premature birth, early rupture of membranes, or low birth weight, potentially due to inflammation of the cervical tissue. However, the evidence for these specific complications is often conflicting. Many studies conclude that HPV does not increase the risk of major pregnancy complications.
Managing HPV Before and During Pregnancy
Before trying to conceive, routine cervical cancer screening, including Pap tests and HPV testing, should be up-to-date. If high-grade abnormal cells (dysplasia) are detected, treatment such as LEEP or a cone biopsy is often performed before conception to eliminate the risk of progression to cancer. Waiting a recommended period, typically six to twelve months, after an excisional procedure allows the cervix to heal before attempting pregnancy.
If abnormal Pap results or high-risk HPV are identified during pregnancy, treatment for the abnormal cervical cells is typically postponed until after delivery. Pregnancy-related changes can make evaluation more complex, and procedures like LEEP carry a risk of complications. Instead, monitoring is performed through a colposcopy (a detailed examination of the cervix). Targeted biopsies may be taken only if there is a suspicion of cancer.
The management of genital warts during pregnancy requires a careful approach. Many self-applied topical treatments are contraindicated because they are not safe for a developing fetus. If warts are small and do not pose an obstruction risk, they may be left alone for the duration of the pregnancy. If the warts are large, multiply rapidly, or could interfere with delivery, a healthcare provider may opt for surgical removal, freezing with liquid nitrogen (cryotherapy), or laser therapy. Consulting with an obstetrician-gynecologist is the best way to develop a personalized management plan.