The Human Papillomavirus (HPV) is the most common sexually transmitted infection globally, often causing no symptoms. The virus is linked to abnormal cellular changes, particularly on the cervix, which may lead to precancerous lesions. Many individuals diagnosed with HPV are concerned about whether the infection interferes with their ability to start a family. This article addresses the relationship between an HPV diagnosis and the biological capacity to conceive.
HPV’s Direct Impact on Conception
The presence of the HPV infection itself does not typically interfere with the fundamental biological steps necessary for conception. HPV is a localized infection of the skin and mucous membranes, affecting the surface cells of the genital tract, including the cervix and vulva. The virus does not generally travel to the upper reproductive organs (uterus, fallopian tubes, and ovaries). This distinction is important because other sexually transmitted infections can cause pelvic inflammatory disease (PID), which leads to scarring and blockage of the fallopian tubes, preventing fertilization.
HPV does not disrupt ovulation, fertilization of the egg, or the implantation of an embryo into the uterine lining. High-risk strains of HPV are associated with causing cellular changes (dysplasia) on the cervix, but the virus does not directly target the mechanisms of reproduction. Some studies suggest that chronic inflammation caused by persistent HPV might slightly reduce success rates in assisted reproductive technologies like in-vitro fertilization (IVF). Furthermore, HPV has been found to potentially affect male fertility by adhering to sperm, which may reduce sperm motility or increase DNA fragmentation. However, for most women, the virus alone does not stop the ability to get pregnant.
Fertility Concerns Related to HPV Treatments
While the virus itself rarely affects the ability to conceive, the medical procedures used to treat advanced HPV-related cervical changes can introduce fertility risks. When precancerous cells are detected through screening, a doctor may recommend a procedure to remove the affected tissue. The most common procedures are the Loop Electrosurgical Excision Procedure (LEEP) and the cold knife cone biopsy.
These excisional treatments remove a cone-shaped wedge of tissue from the cervix to eliminate the abnormal cells. If a significant amount of cervical tissue is removed, it can potentially lead to two main complications related to pregnancy. One is cervical stenosis, a rare condition where the opening of the cervix scars and narrows, which could theoretically slow the passage of sperm. A more common concern is a weakening of the cervix, known as cervical insufficiency or incompetence.
Cervical insufficiency does not prevent conception, but it can affect a person’s ability to carry a pregnancy to term. A weakened cervix may begin to shorten or open prematurely under the weight of a growing fetus, increasing the risk of late-term miscarriage or preterm birth. The risk is generally low and depends on the depth and volume of tissue removed during the treatment. For those with a history of these treatments, specialized monitoring of the cervical length via ultrasound is often recommended during subsequent pregnancies.
Managing HPV Infection During Pregnancy
For those who become pregnant while having an active HPV infection, treatment for the virus or related cellular changes is often deferred. Physicians prefer to postpone definitive treatment of low-grade or moderate abnormal cervical cells until after delivery, as the hormonal and immunological changes of pregnancy can sometimes cause the lesions to regress spontaneously. Immediate surgical intervention is typically reserved only for severe, high-grade lesions or suspected invasive cancer.
Genital warts, which are caused by low-risk HPV types, may grow larger or multiply during pregnancy due to hormonal changes, but they rarely pose a risk to the developing baby. The risk of transmitting HPV to the infant during a vaginal delivery is very low. In extremely rare instances, the virus can be transmitted, leading to a condition in the child called juvenile-onset recurrent respiratory papillomatosis (JORRP), which causes warts to grow in the infant’s throat or airway. A cesarean section is not routinely recommended for women with HPV; it is only considered if exceptionally large warts are present that physically block the birth canal or could cause significant bleeding during delivery.