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Which proceedure is less likely to cause complications in child bearing or the ability to have children? LEEPor a cone biopsy? Which is more effective?

By June 10, 2010 - 6:47pm
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I am 25 years old. After having an abnormal pap showing high grade abnormal cells and positive for HPV, my doctor had me come in for a colposcopy and biopsy so that they could further test the abnormal cells in my cervix.
I just got the results today, which show severe dysplasia... or CIN III.
This means that all the layers of my cells are abnormal, but that the "pre-cancer" has not spread beyond the membrane. I am happy that I do not have cancer yet, though knowing how close it could be has been very emotional and scary and the thought of not having children is equally as upsetting!!

I have to have either a LEEP procedure which my doc seems to be leaning toward for me, or a cone biopsy. I am leaning toward choosing the LEEP, as it seems less invasive with quicker recovery, but I am wondering which is more effective? My doctor says they are both about as effective. She thinks I should be fine with the LEEP procedure. I asked her if there could be complications with getting pregnant and bearing children, and she said there is some data to suggest that women who have these procedures have increased risk of miscarriages, and premature birth... but that it is easy to monitor and prevent in the early months of pregnancy with regular visits, and watching closely. She is pretty reassuring...but I wanted to do more research before making my decision.
Is one of these procedures more effective than the other? Is one more likely associated with complications during child birth? I read somewhere that having the LEEP procedure done more than once can limit your ability to have children... is this true? What are the chances that I would need to have more than one?
If you have any of the answers to these questions I would greatly appreciate the input!

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Hi MissBettie

I have been in your position medically, although I was done having children. In my case, they did the Leep and cone as well. I have had no ill effects although there is some scarring on my cervix. As to your question, I found a clear, concise explanation on Oncolink that I think will help you:

Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:

"Laser, cryotherapy, and excision procedures like LEEP or cone biopsy are all effective methods for treating cervical dysplasia. However, they have different advantages and disadvantages. Cryotherapy is easy to perform, and can be done in the office setting. However, as you mentioned, patients tend to have a profuse discharge, which may be bothersome. Laser therapy requires a short day surgery procedure in the operating room, and usually involves anesthesia. The disadvantage to these two procedures is that they work by destroying the abnormal tissue--there is no biopsy specimen, which can be examined. LEEP and cone biopsies produce a tissue specimen, which can be examined, to ensure there is nothing more serious present that we missed at the time of colposcopy. LEEP may be done in the office, while cone biopsies need to be done as a day surgery procedure. In certain circumstances, a cone should be done instead of a LEEP (when the endocervical curettage shows abnormal cells, when cancer is suspected, etc.) All procedures have a small risk of causing difficulty conceiving, and LEEP and cone biopsies may have a very small risk of causing difficulty with premature cervical dilation. However, these risks are small, and many women go on to have normal pregnancies. It has been our practice to use laser or LEEP for low grade lesions, and to use LEEP or cone biopsy for higher grade lesions (like CIN II-III) because of the ability to obtain a tissue specimen."

Please check out the Oncolink website at http://www.oncolink.org/experts/article.cfm?c=3&s=16&ss=34&id=1958. They have great information and it is run by the Abramson Cancer Center of the University of Pennsylvania.

I hope this helps. If you have further questions, please let us know.

June 11, 2010 - 6:56am
(reply to Cary Cook BSN RN)

Thank you for responding so quickly!! I appreciate your advice :)

June 11, 2010 - 10:47am

Thank you for your question! We will do some more research into the comparisons between these procedures, and respond with some information for you soon.

June 10, 2010 - 8:44pm
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