Get the Facts About HPV, Fertility, and Cervical Cancer

Short for human papillomavirus, HPV is a virus that can be transmitted sexually. There are more than 100 different strains of HPV; of those, about 40 are spread during sex, and of those, about 15 can cause changes to cells in the cervix (the opening of the uterus) that may lead to cervical cancer.

HPV is so common that up to 75% of females will contract it by age 50, says Bradley J. Monk, M.D., an associate professor in the gynecologic oncology division at the University of California Irvine School of Medicine. According to research from the University of Washington, HPV is so widespread that having even one sexual partner significantly raises your risk of contracting it. Almost 30% of females tested positive for HPV within a year of having sex with their first partner, the study showed.

HPV Infection Is Extremely Common

Most people never know they have HPV, says Dr. Monk, because it is usually symptomless (though a couple of strains may cause genital warts), and our bodies can easily fight off the infection over time. HPV can live in the body undetected for years without causing symptoms.

But if the virus doesn't go away on its own (which is more likely as you get older or if you have a weakened immune system), it can cause changes to the cells of the cervix, which may show up as abnormal results during a Pap smear.

According to the Department of Health and Human Services, people with uteruses should start screening for cervical cancer at age 21. For those between the ages of 30 and 65, HPV testing should be automatically done along with the Pap smear for cervical cancer screening. (The DHHS also notes that although HPV is common in people with uteruses who are under the age of 30, it usually resolves on its own and is thus not always tested for.)

Most people with female reproductive systems only learn they have HPV after they've received abnormal Pap results (a sign your body hasn't fought off the virus, yet). It's becoming more common to do simultaneous Pap and HPV testing now, says Dr. Monk, so if your Pap turns up abnormal, the sample can then be screened for HPV without requiring an additional sample (and trek back to the doctor). However, not all labs do this automatically, so you should check with your doctor's office to be sure yours does.

HPV and Abnormal Pap Smears

Abnormal Pap results can mean a number of things, so don't panic. First, know that between 5% and 10% of people who get Paps will have abnormal results at some point. Sometimes, this is just because of a hard-to-read sample or because of another condition (like a recent yeast infection) that makes the results unclear. Even having sex, douching, or getting tested during or after your period can sometimes throw off results. In these cases, your doctor would likely just repeat the test.

If you have an abnormal Pap and test positive for HPV, your doctor will likely perform a colposcopy to learn more about the severity of the changes in your cervix. This procedure involves using a microscope-like tool to examine the cervix and to remove a small sample of cells to be studied in the lab. From there, your doctor will better understand what kind of treatment, if any, you'll need.

Thankfully, having an abnormal Pap smear doesn't necessarily mean you'll get cervical cancer. "There's a huge spectrum here—from merely contracting HPV to actually getting cervical cancer, which is very, very rare, comparatively speaking," says Dr. Monk.

For some perspective, consider the following fact:

• Of all the millions of people who become infected with HPV, only about 10% will get a chronic infection their immune systems can't fight off.
• Only a tiny fraction of those—maybe 1 in 100—will get precancerous lesions (abnormal cells that could become cancer if left untreated).
• Of those with precancerous lesions, there are three basic levels of abnormalities. Most doctors won't even treat the first, mildest level because the abnormal cells usually go away on their own.
• Treating the second two levels promptly usually means the abnormalities won't have the chance to progress into full-blown cancer. Cervical cancer is rare and usually only affects people who don't get Pap smears or regularly see their doctor.

Treating Cervical Abnormalities or Precancerous Cells

Treatment for precancerous cells depends on a few things, including your age and the severity of the cell changes. With mild cases, most doctors adopt a wait-and-see approach with more frequent Pap smears and colposcopies to ensure your body is healing and not getting worse. People with more serious cases have the following options to consider.

LEEP

Loop electrosurgical excision procedure (LEEP) is an office procedure that uses an electric current to remove abnormal cells from the cervix. The tool uses a heated wire loop with an electric current to remove cells from the cervix, which is cauterized to stop bleeding. The typical recovery time for the cervix is around four to six weeks.

Cone biopsy

A cone biopsy is a procedure in which a cone-shaped portion of the cervix (one that contains the precancerous cells) is removed. This is typically performed in a hospital or outpatient surgical center under anesthesia. The recovery time for a cone biopsy is typically four to six weeks.

Freezing and laser

Called cryotherapy, this office procedure uses a chemical to freeze the abnormal cells, which are then shed naturally. The idea is that normal, healthy cells will grow in their place, thus preventing cervical cancer from forming. According to Planned Parenthood, this procedure is 85–90% effective at removing abnormal cells without a recurrence.

Does HPV Affect Fertility?

The HPV virus alone shouldn't have a huge impact on fertility. Although one study found that IVF patients who screened positive for HPV were less likely to become pregnant than those who tested negative, it's unclear why. Researchers speculate that an embryo may have a more challenging time implanting in people whose immune systems cannot clear the virus, but bear in mind that the vast majority of people with HPV fight it off shortly after contracting it.

However, being treated for precancerous cells may slightly raise your risk for problems conceiving. Procedures like cryotherapy, LEEP, and cone biopsy may narrow the cervix and change the consistency of your cervical mucus, both of which can slow sperm down and make it harder for them to reach and fertilize your egg.

Even so, your overall risk of experiencing infertility is very low, says Dr. Monk. Though no studies have researched this area specifically, he estimates that these procedures might impact your ability to get pregnant by less than 5%. You'll likely be advised to avoid sex for a month or so after having any of these procedures, though, which could postpone any plans to conceive.

HPV and Pregnancy

Simply having the HPV virus in your system shouldn't impact your pregnancy in most cases, and your baby won't contract it. If you have genital warts caused by HPV, your doctor may watch you more closely—though pregnant people with this condition usually have healthy pregnancies and can even deliver vaginally.

Procedures like LEEP or cone biopsy during pregnancy are only done when the concern for cancer is very high. People who have these procedures during pregnancy or immediately prior to pregnancy can be at increased risk for miscarriage or preterm birth, says Dr. Monk. These procedures raise your risk of cervical incompetence, where your cervix dilates too early. But your doctor can monitor your cervix through ultrasounds. They may recommend going on progesterone or a cerclage, a stitch that makes the cervix stronger, to prevent this from happening.

Should I Get the HPV Vaccine?

The HPV vaccine (Gardasil 9) is currently recommended for females aged 9 to 26 and males through age 21 —though the Federal Drug Administration (FDA) recently approved it for adults aged 27 to 45.

It has proven extremely effective at reducing HPV infection and abnormal Pap results. The HPV vaccine can also reduce the transmission of genital warts and other cancers caused by HPV, including those of the penis, head, and neck.

A study published in The Lancet reports that the benefits of the HPV vaccine are widespread. In fact, it shows that abnormal Pap smear results were reduced by 50% in females aged 15–19 about five to nine years after they received the vaccine. The study also showed that the vaccine's benefits extend to those who haven't been vaccinated since fewer people are carriers of HPV. Some experts hope that the vaccine could eliminate cervical cancer altogether.

The HPV vaccine protects against four of the most serious strains of HPV: the two that cause cervical cancer and two that cause genital warts. "But even if you've had abnormal Paps or tested positive for HPV, it's still a good idea to get vaccinated because there's no way of knowing which strains you actually have," says Dr. Monk.

Getting the HPV vaccine doesn't completely eliminate your risk of getting cervical cancer, however. The vaccine protects against two strains that cause about 70% of cervical cancers, so even if you're vaccinated, you can still contract other types—and you still need regular Pap screenings.