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Challenge: abnormal cervical screening test in women undergoing infertility investigations or treatment.

Background:

 Approximately 4% of women will have abnormal cervical screening, with the peak age group coinciding with the peak age group of infertility patients.

 Untreated cervical abnormalities can progress to cancer for some, but can regress naturally for others.

 Cervical treatment, particularly at depths greater than 10mm increase the preterm birth rate.

 Those with abnormal cervical screening even without treatment have a higher preterm birth rate compared to those with normal screening histories.

Management options:

 If minor cytologic abnormality is being managed by repeat cervical sample, then proceed with fertility treatment.

 If low‐grade changes, then continue cytologic/colposcopic surveillance, but proceed with fertility treatment.

 If high‐grade changes, then treat. Ideally, wait for reversion to normal with cervical sample +/− colposcopy. In exceptional circumstances, proceed with fertility management early following local treatment.

Prevention:

 Encourage uptake of HPV vaccination.

 Encourage women to take up the offer of HPV screening.

 Encourage all women that smoke to stop.