The Human Papillomavirus (HPV) is the most common sexually transmitted infection globally, affecting the majority of sexually active people. The virus includes over 200 related types, categorized into low-risk types that cause genital warts and high-risk types that can lead to various cancers. While the immune system clears most HPV infections naturally, persistent infections raise questions about family planning. Understanding HPV status in the context of conception, pregnancy, and delivery is important for couples seeking to have children.
HPV’s Impact on Fertility and Conception
The presence of an HPV infection itself does not generally prevent a woman from conceiving. Studies have not established a direct link between the virus and reduced egg quality or the ability of an embryo to implant. Concerns regarding female fertility relate primarily to procedures used to treat high-grade precancerous lesions caused by high-risk HPV types.
Treatments such as the Loop Electrosurgical Excision Procedure (LEEP) or cone biopsy remove abnormal cervical tissue to prevent cancer. While effective, these procedures remove a portion of the cervix, which can sometimes lead to complications. In rare instances, this tissue removal may cause cervical stenosis, a narrowing of the cervical opening that could interfere with sperm passage.
The impact on male fertility is tied to the virus’s presence in the reproductive tract. High-risk HPV DNA is frequently detected in the semen of men experiencing unexplained infertility. This presence is associated with sperm damage, including decreased motility and abnormal morphology, which impairs the sperm’s ability to fertilize the egg.
HPV infection in sperm has been linked to increased oxidative stress and fragmentation of sperm DNA. This damage may impact fertilization success and increase the risk of early miscarriage if conception occurs. While the overall effect on natural conception is often manageable, this association highlights the importance of evaluating both partners in cases of persistent difficulty conceiving.
Navigating Pregnancy While HPV Positive
An existing HPV infection typically does not interfere with the health of the pregnancy, though closer monitoring may be required. Hormonal shifts during pregnancy, particularly elevated estrogen and progesterone, can cause low-risk HPV lesions, such as genital warts, to proliferate or grow in size. This growth is sometimes attributed to the temporary suppression of the immune system during gestation.
If precancerous lesions were present before pregnancy, treatment is usually deferred until after delivery. Procedures like LEEP are typically postponed because they carry a small risk to the pregnancy. Instead, an obstetrician monitors the lesions closely throughout the pregnancy using colposcopy.
The vast majority of women with HPV can safely have a vaginal delivery. A Cesarean section (C-section) is not routinely recommended solely to prevent transmission of HPV to the infant. A C-section is only considered if large genital warts physically obstruct the birth canal or if they are so extensive that they risk significant bleeding during delivery. Warts that grew during pregnancy usually shrink or disappear on their own in the months following childbirth as hormone levels return to normal.
Risks of Transmission to the Infant
The risk of a mother passing HPV to her infant during birth, known as vertical transmission, is low. While the virus can be transmitted through the birth canal, most exposed infants clear the virus naturally without long-term consequences. The decision against a routine C-section is based on the low transmission risk and the established risks associated with major surgery.
Vertical transmission of specific low-risk HPV types (primarily HPV-6 and HPV-11) can lead to Recurrent Respiratory Papillomatosis (RRP). RRP causes non-cancerous tumors, or warts, to grow in the infant’s airway, most often in the larynx. This condition is serious because the growths can obstruct the airway, requiring repeated surgeries to manage.
The incidence of juvenile-onset RRP is exceptionally low, estimated at less than one case per 100,000 children in the United States. Because of this rarity, the benefits of a vaginal birth outweigh the slight chance of transmission for most HPV-positive mothers. Healthcare providers closely monitor the situation and counsel parents on the signs and symptoms of RRP.
Screening, Treatment, and Prevention Strategies
For individuals planning a pregnancy, proactive screening and prevention reduce HPV-related risks. Women should ensure they are current with their Pap smears and HPV testing before trying to conceive. Identifying and treating any high-grade lesions before pregnancy allows the cervix time to heal and reduces the need for intervention during gestation.
If a LEEP or cone biopsy is necessary to remove precancerous tissue, healthcare providers advise waiting at least six months before attempting conception. This waiting period allows the cervix to recover fully, minimizing the small increased risk of preterm labor associated with the procedure. Cervical length can be monitored early in pregnancy for women with a history of extensive excision.
Vaccination against HPV is the most effective preventative measure and should be prioritized for both partners before conception. The current vaccine protects against the types of HPV responsible for most cancers and genital warts, including those associated with RRP. Although the HPV vaccine is not known to be harmful, it is not administered during pregnancy due to a lack of complete safety data for the developing fetus. If a woman becomes pregnant after starting the vaccine series, the remaining doses are delayed until after delivery.