Can I Still Have a Baby With Hpv

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• Open Access
• Published: 01 April 2021

'Does HPV affect my fertility?' Reproductive concerns of HPV-positive women: a qualitative study

• Seyedeh Tahereh Mirmolaei¹,
• Mehrnaz Geranmayeh ORCID: orcid.org/0000-0001-5122-9946 ¹,
• Farnaz Farnam¹ &
• Shahrzad Sheikh Hasani²

Reproductive Health volume 18, Article number:72 (2021) Cite this commodity

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Abstract

Groundwork

Reproductive wellness changes tin occur following infection with Human papillomavirus. HPV is the nigh prevalent sexually transmitted infection causing a diversity of clinical manifestations ranging from warts to cancer. This written report aimed to explore the reproductive concerns of women infected with HPV.

Methods

In this qualitative study, we used the conventional content analysis approach, with the help of MAXQDA.ten software, to analyze information extracted from the face-to-face semi-structured interviews with 20 Iranian HPV-positive women (sampled by maximum variation purposive sampling). The accuracy of this research was ensured according to the four criteria proposed by Guba and Lincoln.

Results

Exploring participants' reproductive concerns, 3 chief categories were identified from the interviews including concerns virtually fertility potential, pregnancy and non-pregnancy reproductive issues. HPV-positive women concerned near reduced female person/ male person fertility due to HPV, the impact of the HPV on the fetal health, agin pregnancy outcomes such every bit miscarriage and preterm delivery, and mother-to-child transmission of HPV during breastfeeding. HPV-positive women with abnormal cytology results were anxious that becoming pregnant or taking hormonal contraception might worsen their abnormalities. Most married women were reluctant to use a condom. Participants requested further data about the potential reproductive risks of the HPV vaccine. They also wanted to know about the safety of HPV vaccine during pregnancy and breastfeeding.

Conclusions

HPV-positive women had some reproductive concerns that should be considered in the designing of educational-consulting interventions. Women need to exist better understood and informed about the impact of HPV on their reproductive health. Health care providers may lack knowledge about these specific areas, and they could benefit from boosted upwards-to-date information to address women's reproductive concerns.

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Plain English summary

HPV is the nearly prevalent sexually transmitted infection among men and women of reproductive historic period worldwide. The role of HPV in cervical cancer is well known. HPV infections are correlated substantially with multiple reproductive organization abnormalities. HPV can be a threat to the reproductive health of patients. Reproductive health refers to "a state of complete physical, mental, and social well-existence and not merely the absence of disease or infirmity in all matters pertaining to the reproductive system and to its functions and processes, as divers by the Earth Health Organization (WHO) and the Un Fund for Population Activities (UNFPA).

In this qualitative study, nosotros conducted face-to-face semi-structured interviews with 20 Iranian HPV-positive women to explore their reproductive concerns. The conventional content analysis approach, with the assist of MAXQDA.10 software, was used to analyze information extracted from the interviews.

HPV-positive women identified some reproductive concerns such as worrying about reduced male and female fertility potential, the impact of HPV on fetal wellness, negative pregnancy outcomes (miscarriage and preterm delivery), and the safe of breastfeeding. HPV-positive women who had abnormal cells in their cervical cytology results were anxious that condign significant or taking hormonal contraception might worsen their health condition. Most participants were reluctant to utilize a condom in spite of being recommended to employ information technology. Women too asked about the potential reproductive risks of the HPV vaccine. HPV-positive women need to be better understood and informed about the impact of HPV on human reproductive in educational-consulting interventions.

Background

HPV is the most prevalent sexually transmitted infection among men and women of reproductive age worldwide [i], and its issue on cervical cancer is well known [2]. HPV testing reaches the maximum level of accuracy in cervical cancer screening [three].

HPV infections are significantly associated with reproductive office abnormalities [1]. In comparison to studies related to HPV oncogenic furnishings, there is a lack of studies focused on the impacts that HPV may take on fertility and reproductive systems. This attribute of HPV infections deserves more attention because of the suggested clan between HPV and reduced fertility or infertility [4]. The information supports the presence of HPV in semen and its proposed role in decreased fertility [2, 5]. It is worth mentioning that HPV Dna has been detected in endometrium and ovaries [6]. In a cohort study conducted in Denmark, no association has been constitute between high-risk HPV and the chance of female infertility [7], simply in a review, information technology was concluded that HPV is associated with abnormalities in fertility and Fine art outcomes [8]. Another study revealed HPV-positive women were 6 times less likely to become meaning after IUI [9]. Other studies establish the detection of HPV at the time of fertility handling has been adversely affected IVF outcomes (lower pregnancy rates and increased take a chance of early pregnancy loss) [x, eleven]. Accordingly, HPV detection and genotyping in both men and women are suggested in infertility diagnosis, at least in idiopathic infertility cases, before IVF procedures [eight]. Scientific literature indicates to high prevalence of genital HPV infection during pregnancy (around 40%) [12] and its clan with adverse pregnancy outcomes such every bit spontaneous abortion, higher incidence of preterm pre-labor rupture of membranes (PPROM), and preterm birth [4, 7,viii,9, 12]. Adequately, HPV positivity in significant women or their partners tin be considered equally a risk of miscarriages and premature rupture of membrane [4, 8]. Two studies indicated that the cervical conization and a LEEP do not necessarily increase the risk of preterm delivery in a subsequent pregnancy [13, 14]. Physiological changes during pregnancy and a decline in the functions of the immune system may increase the risk of oncogenic HPV persistence and progression to intraepithelial lesions in women older than 30 years of age [15]. Moreover, long-term use of birth control pills increases cervical cancer take a chance, importantly for women with persistent HPV infection. Notwithstanding, users of combined oral contraceptives (COCs) have a decrease in immune cells providing a favorable environs for the appearance of HPV lesions [16]. Women may worry about these problems but the literature is limited.

Tseng et al. found the overall frequency of HPV transmission from mothers to neonates was 39.7%, and a meaningfully higher rate of infection was observed when infants were delivered vaginally compared with cesarean [17]. In that location is still much controversy almost the precise style of HPV manual to the fetus/ child. Detection of HPV DNA in semen, endometrium, and ovaries indicates the possibility of transmission even before conception [half-dozen, 18]. Another possible route of infection is intrauterine or prenatal manual; because of the reported presence of HPV Deoxyribonucleic acid in the amniotic fluid, placenta, and cord blood samples. Close contact of the fetus with the infected cervical and vaginal tracts of the mother during commitment can cause perinatal transmission. Maternal history of genital warts in pregnancy was associated with a higher risk of respiratory papillomatosis in the child [nineteen]. Horizontal HPV transmission during breastfeeding or early nursing has too been considered as a significant contributor toward the infant's contagion. Inconsistent results have been found in terms of breast milk as a potential reservoir of viruses [6]. In light of lifelong HPV protection, considering the vaccination of infants is suggested [6].

To appointment, limited qualitative studies accept explored agin psychological responses to HPV diagnosis. Uncertainty about the psychological effects of a positive HPV test highlights the need for further research in this surface area [20]. Almost of the reproductive concerns emerged from these studies. Few studies have addressed the fertility and pregnancy concerns of HPV-positive women. In a study conducted in the United States, it was reported that many women expressed fearfulness associated with role of HPV in their hereafter pregnancy [21]. In other studies, women expressed worries surrounding HPV and female subfertility [22,23,24,25]. I report addressed women's concern virtually the HPV-associated risks of preterm delivery and implications of natural delivery from an HPV-infected birth canal [22]. In some other report women were worried well-nigh the HPV transmission to the fetus [26].

Given the effect HPV may accept on women of reproductive age, the provision of support and interventions for infected women requires a deep agreement of their concerns. The current cervical cancer screening recommendation in Iran is co-testing (HPV testing and Pap smear) strategy for all women aged 30–59, with any marital status, every five years [27], which led to detecting many new cases of HPV in women of childbearing age [28]. Co-testing is available in all provinces of Iran although information technology is not covered by public insurance. Limited studies have mentioned reproductive concerns (often fears of infertility) in general. There have been no qualitative studies to investigate specifically reproductive concerns and informational needs of HPV-positive women particularly in an Islamic cultural background. Therefore, nosotros conducted interviews with Iranian HPV-infected women to meliorate empathise their reproductive concerns.

Methods

The design of the present report is qualitative. It was conducted based on the conventional content assay approach to understand the reproductive concerns of HPV-positive women by exploring their feelings, experiences, and perceptions [29].

This study was carried out from September 2018 to December 2019 at the referral gynecology-oncology outpatient dispensary of Valiasr (located in Imam Khomeini hospital complex, a large, decorated, university-based, and geographically attainable circuitous in Tehran, founded in 1977) serving a large population of women from beyond the land (nearly forty women daily). The clinic is equipped with colposcopy (two gynecology beds) and directed past oncologist-gynecologist SHSH (the last author) and her v colleagues.

A coordinator of Valiasr clinic sent all women who tested positive for HPV (either simply high-risk HPV or both high-hazard/low-risk strains) to the interviewer (KQ-female person- no relationship with participants) in the calm, convenient room to provide them with information about the purpose and methods of the study. Women were eligible for interview if they were over eighteen with a heterosexual partnership (with any marital condition including: single, married, widow, divorced); had no severe disease (including cervical cancer) and were willing to share their experiences. A maximum variation purposive sampling was used to recruit information-rich candidates with diverse age, marital status, education, and socioeconomic condition. In total, 20 Persian-speaking women with different ethnic, cultural, and religious backgrounds were included. Ii invited women refused to participate because they prefer not to talk over HPV. Since the clinic is crowded, all participants interviewed during their waiting hours. Semi-structured 1-to-one interviews were conducted using an interview guide (Appendix 1) started with the demographic background and reproductive and screening history. 3 pilot-interviews were done (included in the written report) to improve questions. Memos aided to pattern the next questions of the subsequent interviews. Besides, field notes were written during the interviews. Face-to-face in-depth interviews with participants' consent were recorded (lasted between 35 and 90 min), transcribed verbatim, and collected until information saturation was reached over fifteen months.

The information assay was performed concurrently with data collection, using a qualitative content analysis arroyo described by Burnard et al. [30] using MAXQDA ten software. Initially, interview transcripts, memos, and field notes were integrated, and two coders (KQ and STM) read the transcriptions multiple times to codify a full general agreement of the whole data. Open coding was based on this approach. Chief codes were and so reduced past abiding comparison and combination. The extracted codes were and then brought together in terms of similarities and differences. The sub-categories with similar content were interpreted in a higher level of abstraction into the primary categories.

The accuracy of this qualitative research was ensured according to the iv criteria proposed by Guba and Lincoln, namely credibility, dependability, confirmability, and transferability [31, 32]. The credibility criterion was achieved through prolonged date and member checking, by which, the transcript and extracted codes from the interview were returned to each interviewee to approve their accuracy. Confirmability and dependability of the results were ensured by peer debriefing and external checking. Therefore, 2 observers reviewed and rechecked all transcripts, codes, and themes. Finally, this process completed with numerous discussions among the research team about areas of disagreement until reaching a terminal consensus. To enhance the transferability of the results, we tried to consider the maximum variation during sampling. We interviewed women with diversity in age, relationship status, education, socioeconomic status, and cultural groundwork. In qualitative research, generalizability is labeled every bit a full description of the setting, the participants, and the themes in rich detail through the lens of the exterior reader. To attain dependability, the process within the study was described in detail.

This study was undertaken as a part of a Ph.D. thesis in Reproductive Health, which was reviewed and approved past the Ethics Commission of Tehran Academy of Medical Sciences (IR.TUMS.FNM.REC.1397.139). Moreover, Valiasr hospital managers willingly facilitated the study. Written informed consent was obtained from all the participants. Straight quotes that are representative of the participants have been presented. Only the quotes used in the current manuscript take been translated into English.

Results

The characteristics of 20 women interviewed demonstrate the heterogeneity of the sample (Table 1). Half of participants had children and 70 per centum (fourteen) were married. Participants averaged 33.ix years (aged 23–47). 70% of participating women had a university pedagogy. Details in parentheses following quotes represent the participant's identification number.

Tabular array 1 Demographic characteristics, HPV genotypes and cytology results of participants

Full size tabular array

Many women reported seeking information nearly fertility and pregnancy from a range of sources, including the Internet (social media, blogs and websites run by individual laboratories and specialists), their healthcare provider, and other women with HPV. They indicated that finding upwardly-to-engagement trustworthy data was challenging. Nigh women preferred information provided past formal websites. Participants identified many fertility and childbearing concerns. The 3 primary categories extracted from the interviews were "concerns near fertility potential," "pregnancy concerns," and "non-pregnancy reproductive concerns" (Table two).

Tabular array 2 Extracted categories and sub-categories from the interview data

Total size table

Concerns near fertility potential

One of the most repeated concerns of HPV-positive women was fear of fertility impairment in both male and female patients by and large expressed by younger women who had pregnancy plans.

Adverse effects of HPV on male fertility

Some participants had questions about the presence of the virus in semen, sperm, and penis skin. They showed concerns about the effect of HPV on male fertility.

"Nosotros've been told to employ a condom. Does this virus become into my hubby'south sperm? Isn't it weakening his fertility? I'm worried, it's because of this infection that I haven't got significant these years" (P.ten).

Women with mixed HPV types whose husbands had genital warts (GWs) were mainly concerned nigh the importance of removing warts before conception.

Negative event of HPV on female fertility

Participants were broken-hearted and needed more data about the upshot of papillomavirus on hormones and the reproductive system.

"You know why I'thou worried? If I had a baby at present, I wouldn't care virtually HPV. I'thousand 37. I have to become pregnant soon. I may lose my run a risk of getting pregnant. Does the virus impact my ovaries?" (P.x).

Some expressed fearfulness and anxiety almost losing their fertility due to getting cancer following persistent high-run a risk HPV.

I'm convinced that I am going to get cancer and I might never exist able to have a baby in the future. I'thousand depressed because I'm not sure I can preserve my ability to get pregnant." (P.7).

Few women attributed the failure of assisted reproductive techniques (Art) to HPV.

"Nosotros've been trying to conceive for six months with no luck. Nosotros did IUI (Intra Uterine Injection) twice. I asked my doctor; she said the virus could be in the semen." (P.viii).

Threatened female fertility association with treatments and vaccine

Women were concerned that therapeutic procedures (cryotherapy, loop electrosurgical excision process (LEEP), and conization) might impact their power to go pregnant. A single woman who was most to take LEEP surgery for her cervical intraepithelial neoplasia (CIN)-two, expressed her business concern as follows:

"I'm non pitiful that I'm not getting married at all. I'thousand heartbroken that I don't know why, from the moment I find out [nearly HPV], I can feel … how much I wanted to have a baby. They (doctors) say in that location may not be a problem with this operation [LEEP], but there's. It can narrow the cervix and make information technology hard to become significant. All of those things run through your head." (P.12).

A wife planning to get meaning after a LEEP asked:

"When tin can I start trying to conceive after a LEEP?" (P.19).

Few women were concerned about the potential consequence of HPV vaccine on menstruation and fertility.

"I was spotting and lethargic every fourth dimension I was vaccinated. Does HPV vaccine touch the period? I've read on Instagram that HPV vaccine can crusade infertility" (P.xiv).

"Tin can Gardasil shots cause missed periods?" (P.xvi).

Pregnancy concerns

Pregnancy for women infected with HPV had some challenges, mostly over personal health. Participants also expressed worries about fetal harm and adverse pregnancy outcomes including miscarriage, preterm delivery and cesarean section.

Threatened mother'due south health during pregnancy

Nigh HPV-positive women with abnormal cytology results were broken-hearted that weakening the immune system during pregnancy could lead to the virus persistence in their body, and worsen cervical abnormalities. This fear was and then swell that some who had decided to become pregnant soon inverse their pregnancy plans, postponing them until their cytology and HPV results return to normal.

"I wanted to become pregnant, so I went to a specialist for a checkup. At present that my examination results [Pap, HPV, and colposcopy] came abnormal, I recollect it'due south non an appropriate time for me to go meaning. I'chiliad afraid pregnancy will make my results worse. I'm going to wait for the virus to get abroad, then get pregnant." (P.1).

"I wanted to go pregnant. Then it happened [high-risk HPV and Atypical Squamous Cells of Undetermined Significance (ASC-Usa)], and I can't call up of pregnancy anymore. My doctor said I could get significant, but I'm agape I'll go pregnant, and my immune system volition go down, then my abnormal cells will grow." (P.6).

Some participants expressed concern nigh the safety of diagnostic and therapeutic procedures during pregnancy. They were worried that becoming pregnant would deprive them of timely treatment.

"Is colposcopy immune in pregnancy? Could I be treated during pregnancy, if I go a serious precancerous condition?" (P.6).

Women with mixed HPV genotypes worried most increasing their warts during pregnancy. These thoughts discouraged and frustrated them.

"Pregnancy causes warts to multiply or become more noticeable. They're disgusting." (P.2).

They likewise had questions about preferred GWs treatments during pregnancy.

"If I get warts, what treatments are available for significant women? Can I freeze information technology?" (P.10).

Adverse pregnancy outcomes

Most women planning to have children in the future were concerned about the implications of infection on their (potential) child. women interviewed mentioned the clan between genital HPV infection and diverse maternal and fetal variables and pregnancy complications such as miscarriage and premature delivery.

"I had a miscarriage last year. Was it from this virus? My Pap smear was always normal. What if I get significant and have a miscarriage again?" (P.4).

Women stated treatments similar LEEP or conization might compromise their ability to comport a child to term by weakening the lining of the neck.

"My sister'southward physician removed abnormal cells from her cervix. Subsequently that, she became pregnant and her baby was born in the 35th week." (P.3).

Considering cesarean delivery for women with HPV was another thing posed by the participants. Some of them mistakenly believed that having genital warts was an indication of cesarean delivery to avoid perinatal evolution of laryngeal papillomatosis in the newborn.

"My doc said if I had warts, I'd have a cesarean section. Thank god I did non have warts and I gave birth naturally." (P.2).

Misconceptions amongst healthcare professionals revealed in this regard which has caused business organization among women.

Impairment to the fetus

Fetal health was the chief business organization about pregnancy raised past almost women interviewed. Participants too reported that they often plant it challenging to find adequate data about this issue. They needed to know what to do to protect their kid from the infection. In this regard, one of the participants planning to go pregnant before long stated:

"I worry about passing HPV to the baby during pregnancy and childbirth. What would I practise to stop that?" (P.4).

Since anogenital warts can proliferate during pregnancy, removal of warts during pregnancy was another result that was raised. Women with GWs revealed information needs surrounding the teratogenicity of some wart-removing treatments. They felt anxious near any threats that might pose to the fetus.

"Doc gave me Podophyllin, saying I shouldn't go pregnant while using information technology. I'm afraid I'g significant. I want to know which wart-removing medicine is safe in pregnancy." (P.4).

They also wanted to know if intercourse during pregnancy would increase the chance of HPV transmission to the fetus.

Nigh all women interviewed reported beingness brash to take the HPV vaccine. Participants knew little about the safety of the HPV vaccine (mostly Gardasil) in pregnancy. Women who wanted to get significant preferred non to go pregnant until they completed the vaccine series.

"I asked about vaccination and pregnancy. Md recommended postponing vaccination until after pregnancy. Only I'd rather to get vaccinated first." (P.2).

Non-pregnancy reproductive concerns

Some reproductive concerns unrelated to pregnancy accept reported in the 3rd category. V challenges discussed in this category were breastfeeding, contraception method, premature menopause, cervical cancer, and familial cancer.

Fear of infecting newborn

Two women mentioned the likelihood of passing HPV to a child through breast milk or early nursing.

"Does HPV affect breast milk, I mean, but like a diet? Does breastfeeding cause mouth warts? Should nosotros avert breastfeeding?" (P.iii).

Concerns related to contraception method

To avoid unplanned pregnancies, women with HPV needed more data to cull preferable contraception. Every bit long-term use of birth command pills increases the cervical cancer risk for women with persistent HPV, users recommended changing their contraception method. Women were worried about the negative impacts of combined oral contraceptives (COCs) and levonorgestrel (LNG) pills on their cellular changes.

"We use the pull-out (withdrawal) to prevent pregnancy, but sometimes I apply emergency pills. I don't know if they can weaken my immune system. I read online that nativity pills may induce cervical cancer. Are the emergency pills as harmful as the COCs?" (P.17).

"I've taken LD (low dose COC) pills later my daughter was born, which is about nine years. They said I have to end taking them. I don't know what to do. My husband does not employ a safe." (P.11).

Some women in a monogamous relationship reported they (or their husbands) are reluctant to use a rubber. They wanted to know why using a safe is essential for HPV-positive patients when they already had HPV.

Fear of premature menopause

A few women over 40 who had no pregnancy intention mentioned concerns about early menopause. Testing positive for loftier-run a risk HPV genotypes and abnormal cytology have made these participants fearful of premature ovarian insufficiency.

"I take noticed my periods becoming infrequent. I've tested positive for HPV 16. I feel that my periods get missed and irregular due to this disease. Could this virus crusade me to menopause? I'm worried I'thou in menopause. I don't like to get there." (P.18).

Another stated: "I had a hysterectomy concluding year (because of fibroids and heavy periods). They hadn't removed my ovaries. I also had a high-risk HPV 53, only I got vaccinated, I'm worried most the effect of HPV on my ovaries." (P.xv).

Fear of cervical cancer

Ane of the virtually common concerns of women tested positive for HPV was cervical cancer that has described in a unlike manuscript every bit the psychological response to HPV diagnosis. A context-specific finding that seems specific to societies that adhere to cultural principles was fear of cervical cancer in virgin single women. Since vaginal virginity is a matter of prestige in most parts of Iran, they reported engaging in sexual intercourse without vaginal penetration. 2 virgin women have expressed concern virtually cervical cancer following an ascending HPV infection from the perineum to the neck. Later getting genital warts and learning about HPV-related cancers, they were worried almost cervical cancer. One revealed that:

"Yous don't know what is going on considering y'all tin can't take Pap smear or colposcopy. I was scared. My gynecologist performed so-called Girly Pap smear. She took a cotton swab sample from the end of the vagina for HPV typing and cytology." (P.sixteen).

Fear of familial cancer due to HPV

Few women were anxious most the possible clan between HPV and history of cancer in their female person family members.

"My sister had a mastectomy final year. I wonder her cancer was associated with HPV. We both take HPV. I'm scared what if it's a familial thing, and then I might become cancer also." (P.9).

Some other woman with CIN-2 and high-run a risk types mentioned:

"My mother died of cancer. Did information technology take anything to do with HPV?" (P.20).

Discussion

The present study aimed to shed some lite on the reproductive concerns of women infected with HPV and found they have reproductive concerns and informational needs over the effects of HPV infections on male and female fertility potential, the success of Fine art techniques (including IVF and IUI), fetal and newborn wellness, mother health and pregnancy outcomes. Our participants had questions and worries about the presence of HPV in the semen and the touch on of HPV infection upon male person fertility. Although concerns over male person subfertility in HPV-positive men has received far less attending in previous qualitative studies, concerns well-nigh female fertility were generally mentioned in previous studies [23,24,25, 27, 33, 34]. Our findings highlighted reproductive concerns in more than details as mentioned above.

One study, conducted in Republic of lithuania, has identified HPV-52 equally the most mutual form of HPV in couples undergoing IVF1. Interestingly, the ii participants who expressed the well-nigh concern over infertility were diagnosed with HPV-52. We believe more enquiry should be conducted on the relationship betwixt HPV-52 and infertility. Worries well-nigh the failure of ART procedures, including IVF and IUI, due to HPV infections exercise non seem to be unfounded, according to literature [9,10,eleven]. Health care providers demand to have these concerns seriously and consider referring women to specialized level.

Fertility fears about the HPV-vaccination amongst women diagnosed with HPV accept been reported in a qualitative study [17]. Our participants expressed their fear of losing fertility after getting HPV vaccine. It can exist due to considerable media attending to the safety of the HPV vaccine. World Health Arrangement (WHO) has cited to a systematic review that ended no causal relations between HPV vaccination and infertility [35]. In the present written report, the participants feared that the accidental injection of the HPV vaccine during pregnancy would crusade adverse pregnancy outcomes or harm to the fetus. Women should be informed by healthcare providers that although pregnancy testing is not necessary before the vaccination, the vaccine manufacturers and WHO recommend avoiding HPV vaccination during pregnancy. In cases of unintentional immunization of significant women, no intervention is needed [36, 37].

In agreement with other studies, our participants mentioned fertility concerns about conservative treatment for CIN like LEEP and conization [22, 24, 34]. Research has yielded mixed results, but one study indicates that fertility is not affected by a LEEP [38].

Pregnancy concerns were the 2nd category extracted from the interview information. Women mentioned that worrying about the adverse effects of pregnancy on their health was the main reason they decided non to become pregnant. In a mixed-method report conducted in the United States, 30 of 94 women who planned on getting pregnant indicated that their HPV examination results would alter their future pregnancy plans [39]. Women infected with HPV needed to know what they need to exercise to have a healthy pregnancy. They may as well face barriers seeking and obtaining information to address their reproductive concerns [36].

In line with our findings, ii studies also indicated concerns almost the association between HPV infections and adverse pregnancy outcomes such as spontaneous abortion and preterm delivery [22, 34]. In conjunction with Pourmohsen'due south report, maternal-to-fetal HPV manual was a mutual concern, particularly among married who had the pregnancy plans. Women interviewed thought natural childbirth may pose a manual risk to a newborn. Another qualitative study reported this business concern [22]. Although there is still controversy almost adverse effect of HPV on pregnancy outcomes, women may worry most these issues and physicians need to accost these concerns. Most participants reported being highly concerned about the condom of wart-removing medications and diagnostic and therapeutic interventions for cervical cell changes during pregnancy. They asked about the safest way to remove GWs. In a study, CO2 laser vaporization has been suggested equally a safety, unproblematic treatment for warts during pregnancy [40].

Nearly all interviewed women had been recommended to use a condom. Most married reported that they (or their husbands) are reluctant to use a condom. They wanted to know why constantly using condoms is essential while they already are HPV-infected. Caregivers should also explain why they recommend using a condom.

Some women with a history of taking hormonal contraceptives pointed out they take been recommended to stop taking combined hormonal pills. HPV-positive women raise some concerns nigh choosing their contraceptive method. Although, to conclude causality between COCs and HPV lesions, more studies are needed [sixteen], detail attention should be given to discuss contraception methods with HPV-positive women.

Such richness from the interviews revealed unexpected concerns such equally fear of having an ovarian tumor and getting cancer because of a family history of cancer. They considered HPV to be a familial carcinogen factor. Similar concerns indicated by another study [41].

The just context-specific finding was the fear of cervical cancer in unmarried virgin women. Communities define 'virginity' in the different ways. In our guild intact hymen determines someone's virginity. In this Islamic-Iranian context HPV-positive virgin women avoid vaginal examination. To reassure these women, doctors take a so-called "Girly Pap smear" from the upper part of the vagina with a cotton fiber swab. Our findings revealed misconceptions regarding the relationship between non-penetrative sex and STIs among single women. These women withal followed up with the gynecologist merely did not take a proper pap-smear and hence may miss out on the opportunity of beingness diagnosed properly.

In previous studies, the reproductive concerns of HPV-positive people had been discussed every bit a office of emotional and psychological responses to HPV diagnosis. Our findings are noteworthy considering equally far as nosotros are aware, this is the only qualitative report in which reproductive concerns of HPV-positive women have received particular attention. Furthermore, women with diversity in HPV genotypes (both loftier-take chances and low-run a risk) were interviewed. As queries about sexual health were function of the interview content, they will be discussed in another manuscript entitled "Sexual life of HPV-positive women." One of the limitations is that the study was conducted amongst women attention 1 colposcopy clinic. Still, this referral clinic is likely to reflect other clinics in Iran since it covers a varied population. Perchance women who were interested in the topic decided to participate, and it applies to all qualitative research. We should annotate on the possible affect of having a highly educated sample (~ 70% with university education) as another limitation. Unlike previous studies that women with genital warts are ofttimes excluded, a subset of our participants was HPV-positive women who had GWs. It is worth noting that these women may have additional concerns that must not exist disregarded. Moreover, the relative weight or importance of themes and categories is non always credible. The credibility of the process is demonstrated in the sentiments stated in the information prepare, suggesting that the extracted concerns may be transferrable to other settings. An additional strength is that this paper complies with the COREQ checklist designed for the reporting of qualitative studies [42].

Conclusions

The findings of this qualitative study suggest HPV-positive women'southward concerns most the possible effect of HPV on male and female fertility, pregnancy outcomes, mother and child health, breastfeeding and contraceptive methods. Most of these concerns were based on actual proven correlations and should be addressed. These concerns demand to be taken into account when Health care providers are counseling HPV-positive women. Medical professionals need to take women'south informational needs more seriously to become one stride closer to helping these women improve their reproductive wellness. Extracted concerns which are based on misinformation, such as recommending C-section for women with GWs or fright of HPV vaccine, require increasing education /awareness for patients and/or healthcare providers. Moreover, health intendance providers could benefit from boosted training to exist prepared to mitigate HPV-positive women'southward reproductive concerns. Women demand to have better informational resources about these sensitive topics and then that they tin make informed decisions about having children. Some women may as well benefit from referral to a specialist in the context of assisted reproduction.

Availability of data and materials

The datasets used and/or analysed during the electric current study are available from the corresponding author on reasonable request.

Abbreviations

HPV:

Human Papilloma Virus one

UNFPA:

Un Fund for Population Activities

WHO:

World Wellness System

GWs:

Genital warts

ART:

Assisted reproductive techniques

IUI:

Intra uterine injection

LEEP:

Loop electrosurgical excision procedure

CIN:

Cervical intraepithelial neoplasia

ASC-U.s.a.:

Atypical squamous cells of undetermined significance

PPROM:

Preterm pre-labor rupture of membranes

COCs:

Combined oral contraceptives

LD:

(Low dose) combined oral contraceptives pills

LNG:

Levonorgestrel

IVF:

In vitro fertilization

STIs:

Sexually transmitted infections

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Acknowledgments

We thank the colposcopy clinic staff at the Valiasr Infirmary and anybody who helped with recruitment and all the women who participated in the study.

Funding

The enquiry was funded by Tehran University of Medical Sciences for a Ph.D. thesis in Reproductive Wellness.

Author information

Affiliations

1. Reproductive Wellness Department, Schoolhouse of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat St. Tohid Sq., 141973317, Tehran, Iran

   Kowsar Qaderi, Seyedeh Tahereh Mirmolaei, Mehrnaz Geranmayeh & Farnaz Farnam

2. Gynecology Oncology Section, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Islamic republic of iran

   Shahrzad Sheikh Hasani

Contributions

KQ, STM, MG, FF, and SHSH designed the report. KQ conducted the interviews. STM and KQ planned and undertook the assay. KQ wrote the initial and subsequent drafts of the manuscript. STM, MG, FF, and SHSH contributed to revising the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mehrnaz Geranmayeh.

Ethics declarations

Ethics approving and consent for participation

Written informed consent was obtained from all the participants. This study was reviewed and approved past the Ethics Committee of Tehran University of Medical Sciences (IR.TUMS.FNM.REC.1397.139).

Consent for publication

Non applicable.

Competing interests

The authors have no conflict of interest.

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Appendix 1: Interview guide

Appendix 1: Interview guide

"What do you know most HPV?", "What have you been told or what do y'all know almost the effects of HPV on the reproductive system of both men and women?", "Please tell me near your experiences, thoughts, and feelings regarding pregnancy and childbearing?", "Are yous experiencing whatever concerns?", "How exercise you describe pregnancy and maternity while infecting with HPV?", "Is your personal pregnancy plan afflicted past the diagnosis? And how?", and "What you need to know as a woman infected with HPV almost your reproductive health (menstrual cycle, union, contraception, pregnancy, breastfeeding, menopause, and gynecological cancers)?", "How you seek for answer to your questions?" and "Which source of information do you prefer? And why?" Open questions such equally "What practice you mean?" and "Please expand" were used to extract more clear and detailed responses.

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Qaderi, K., Mirmolaei, Southward.T., Geranmayeh, One thousand. et al. 'Does HPV affect my fertility?' Reproductive concerns of HPV-positive women: a qualitative report. Reprod Health 18, 72 (2021). https://doi.org/10.1186/s12978-021-01126-7

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• Received: 23 August 2020

• Accepted: 21 March 2021

• Published: 01 Apr 2021

• DOI : https://doi.org/10.1186/s12978-021-01126-7

Keywords

• Reproductive wellness
• Qualitative inquiry
• Fertility
• Female person
• Warts
• Human papillomavirus
• Iran
• Papillomavirus infection
• Pregnancy outcome
• Sexually transmitted diseases

Can I Still Have a Baby With Hpv

Source: https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-021-01126-7

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