Summary of findings for the main comparison. Fertility outcomes for cervical intraepithelial lesions.
| Fertility outcomes for cervical intraepithelial lesions | ||||||
| Patient or population: patients with cervical intraepithelial lesions Setting: colposcopy clinic Intervention: cervical treatment for CIN (excisional or ablative) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Untreated | Cervical treatment for CIN (excisional or ablative) | |||||
| Total pregnancy rate | Study population | RR 1.29 (1.02 to 1.64) | 38050 (4 studies) | ⊕⊝⊝⊝ very low1 | Observational studies only 1 study assessed as low quality. 2 studies downgraded to very low quality due to study design (high risk of publication bias) and wide confidence intervals. 11 study upgraded to moderate quality due to large study population and magnitude of effect. |
|
| 382 per 1000 | 493 per 1000 (390 to 627) | |||||
| Control population | ||||||
| 368 per 1000 | 475 per 1000 (375 to 604) | |||||
| Pregnancy rate in women with intention to conceive | Study population | RR 0.93 (0.8 to 1.08) | 70 (2 studies) | ⊕⊝⊝⊝ very low2 | Observational studies only 2 studies assessed as very low quality due to study design (high risk of publication bias) and wide confidence intervals. |
|
| 946 per 1000 | 880 per 1000 (757 to 1000) | |||||
| Control population | ||||||
| 950 per 1000 | 883 per 1000 (760 to 1000) | |||||
| Conception at > 12 months | Study population | RR 1.45 (0.89 to 2.37) | 1348 (3 studies) | ⊕⊝⊝⊝ very low3 | Observational studies only 2 studies assessed as low quality. 1 study downgraded to very low quality due to study design (high risk of publication bias) and wide confidence intervals. |
|
| 92 per 1000 | 117 per 1000 (62 to 222) | |||||
| Control population | ||||||
| 140 per 1000 | 178 per 1000 (94 to 336) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; CIN: cervical intraepithelial neoplasia; RR: risk ratio; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1Downgraded to 'very low' due to very high heterogeneity (I2 88%).
2Downgraded to 'very low' due to all included studies assessed to be at high risk of publication bias, cohorts being poorly representative of the entire population and poor response rate to study questionnaire.
3 Downgraded to 'very low' due to high heterogeneity (I2 63%).