The human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States. In fact, according to the Centers for Disease Control and Prevention (CDC), HPV is so common that “nearly all sexually active men and women get the virus at some point in their lives.” With at least 150 types of HPVs that we know of, it’s no wonder that 79 million Americans have at least one type. But fear not!
While it’s true that some STIs can lead to infertility, there’s no need to freak out in the case of HPV. HPV on its own shouldn’t affect your ability to conceive. However, because HPV is often asymptomatic (meaning there aren’t any obvious signs or symptoms), it’s also one of the least treated STIs. Most of the time, that isn’t a big deal. But depending on the type of HPV someone has, there can be an increased risk of developing cancer or precancerous cells on the cervix, which do require treatment. The treatments to remove these abnormal cervical cells can, in turn, affect fertility—this is when discussing fertility if you have HPV becomes really important so let’s talk about it.
What is HPV and what causes it?
We’re gonna back up for a second here and explain the basics of HPV. HPV is actually an umbrella term for a group of over 200 related viral infections that affect the outer skin layers of the genitals, mouth, hands and feet. So, while transmission can happen without sexual intercourse, the vast majority of HPV infections are the result of unprotected sex.
In these cases, you can get HPV by having vaginal, anal, or oral sex with someone who has the virus but it’s most commonly spread during vaginal or anal sex. It also spreads through close skin-to-skin touching during sex. A person with HPV can pass the infection to someone even when they have no signs or symptoms.
Because of this, if you’re sexually active at all, you can get HPV—even if you’ve had sex with only one person. You can also develop symptoms years after having sex with someone who has the infection. This is why doctors usually can’t tell you when you might have gotten it.
Types of HPV and treatments
Of the many types of HPV, only some are of actual concern and could therefore affect fertility, either due to the virus itself or the treatments used to manage it. Low-risk HPVs mostly cause no disease and typically go away on their own within 2-3 years. However, a few low-risk HPV types can cause warts on or around the genitals, anus, mouth, or throat. High-risk HPVs can cause several types of cancer. There are about 14 high-risk HPV types including HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. Two of these, HPV16 and HPV18, are responsible for most HPV-related cancers.
As mentioned earlier, most HPV infections don’t cause cancer. Your immune system is usually able to control HPV infections so they don’t progress to cancer. However, high-risk HPV infections are more likely to persist and can eventually cause cervical cancer. In these cases, the immune system is not able to control the HPV infection and as the high-risk HPV infection lingers for many years, it can lead to abnormal cell changes that, if untreated, may worsen over time and become cancer.
If your doctor decides that they need to remove abnormal cells, they’ll use one of the following treatments:
- cryotherapy, or freezing and eliminating the abnormal tissue
- a cone biopsy (conization) to remove part of the cervix
- a loop electrosurgical excision procedure (LEEP), which involves removing cells with a wire loop that has an electrical charge
We’ll talk more about how these procedures can affect your fertility later on.
How does HPV impact fertility?
While most HPV infections clear up on their own (and rarely make themselves known through noticeable symptoms), the infections that persist can have a negative impact on fertility for all genders—either due to the infection itself or the treatments used.
Fertility risks associated with HPV include:
- Damage to the cervix via HPV itself or the treatment used to remove affected tissue from the cervix
- Decreased ovarian reserve
- Damage to sperm or parts of the male reproductive system
HPV and cervical function
First and foremost, HPV can damage the cervix directly over time if left untreated. This is why it’s so important to get those annual exams and routine pap smears with HPV testing! Most of the time, testing is the only way to know for certain whether a person has HPV or not. Once HPV has persisted for a long time or is getting more severe, it’s time to remove abnormal cells with one of the procedures mentioned earlier–cryotherapy, cone biopsy, or a LEEP. These procedures can most notably affect your ability to reach full term in a future pregnancy but this depends on several factors including how large and deep the area to be treated is.
In all cases, cell removal can change your body’s cervical mucus production. The procedures may also cause stenosis, or a narrowing of the opening of the cervix. This can slow down sperm and make it harder for an egg to get fertilized. Cones and LEEPs can also cause the cervix to weaken. While this won’t cause infertility or difficulty getting pregnant, it can lead to cervical insufficiency, which can cause your cervix to painlessly open and thin before your pregnancy has made it to term, and lead to a preterm delivery.
HPV and ovarian reserve
There have been several interesting studies about HPV and ovarian function but overall the literature is a bit of a mixed bag. Overall, research has suggested that HPV infection may be associated with a higher rate of spontaneous loss or underdevelopment when undergoing IVF. One study that compared HPV positive and HPV negative people found that a decreased ovarian reserve was more common in the HPV positive over the HPV negative group. Another study looked at HPV positive and HPV negative people undergoing IVF and their response to stimulation. No significant difference was seen in the responsiveness to controlled ovarian stimulation in terms of the number and maturity of retrieved eggs or in terms of fertilization rates. Finally, a recent study published this year showed no effect on live birth rates when comparing people with and without HPV.
HPV and its effects on male partners
Several studies have shown a link between HPV and decreased fertility for male partners. In particular, sperm containing HPV has been shown to negatively contribute to both male and couple infertility. One study done in 2011 found that men who had HPV were more likely to have an impairment of certain sperm parameters, like motility. This was confirmed in another study done in 2015. On top of that, if sperm containing HPV fertilizes an egg, there may be an increased risk of early miscarriage.
Can I freeze my eggs if I have HPV?
The good news with all of this is that an HPV diagnosis alone should not affect your ability to get pregnant or to freeze your eggs. Most fertility specialists will require an up to date pap smear and HPV test as part of their evaluation and you’ll usually be allowed to continue with the freezing process as long as the HPV is low-risk, since those cases are expected to clear on their own.
If you do have a high-risk HPV, you’ll need to discuss those results with both your OB/GYN and your fertility doctor to figure out what next step is right for you. Depending on the specific HPV strain, if there are any lesions and how advanced they are, your doctor will recommend continuing with egg freezing or delaying until after treatment.
If there are precancerous cells in the cervix, minor treatment through cryosurgery or LEEP will be necessary and this is almost always recommended before trying to get pregnant or undergoing any other fertility treatments, including egg freezing or IVF. For the most part, these procedures don’t affect reproductive potential though and most people go on to have healthy pregnancies once they’ve recovered.
Risks and benefits of egg freezing with HPV
The main risk of freezing with HPV is the concern for a lower yield and the quality of eggs retrieved. As mentioned before, some studies have shown that HPV does have an effect on ovarian reserve but others have shown little to no differences in IVF outcomes. There are also so many additional factors that affect a person’s fertility. Your provider is going to be the best person to tell you whether your case warrants clearing the HPV before moving ahead with egg freezing. The benefit of egg freezing with HPV is that you’re taking a proactive step to preserve your future fertility. Whether your HPV is low- or high-risk, whether you require treatment or not, you’ll know you’ve safeguarded your options.
Can I donate eggs if I have HPV?
The donor egg screening process will vary somewhat from clinic to clinic but here at Cofertility, our goal is to be as clear as possible about what this involves. All potential donors will be assessed in terms of their age, AMH levels, medical and family history, psychological and physical health. Making sure your pap smear and HPV testing are up to date is included in this process.
HPV won’t automatically disqualify you from becoming an egg donor since it’s not transmittable through your eggs. However, as mentioned before, this will depend on which HPV type, whether it’s low or high-risk, and whether there are any precancerous or cancerous lesions found during the screening process. For a full list of disqualifications for egg donation through Cofertility, click here.
The takeaway from all of this at the end of the day is that preventive care is king! Protecting yourself from HPV by getting vaccinated and making sure to get your pap smears on time can not only decrease your cervical cancer risk (which is a pretty good reason all on its own) but it can also lower your risk for preventable pregnancy or fertility concerns down the road.
While there’s still more research to be done on the effects of HPV on fertility in all genders, it can safely be said that discussing HPV and fertility with your healthcare providers should be at the top of your list. This is especially true if you have HPV and end up requiring more invasive management—your providers can help you make a plan about your fertility future before any treatments begin.
Egg freezing and HPV can be confusing individually so you’re not alone when it comes to questions and concerns around both topics and how they affect each other. Freeze by Co is here to help you every step of the way. With our Split program, people between 21 to 33 years old have the chance to freeze their eggs for free! After a “Split” cycle, you would donate half of the eggs retrieved to a family that’s trying to conceive and freeze the remaining half for yourself.
If you’re over 34 or not interested in donating half the eggs retrieved, you can still participate in the Keep program up to age 40. You would be able to freeze your eggs and keep them all for yourself, on your timeline while having access to an additional valuable resource in our support community. Our private, online community allows you to engage with other people freezing their eggs at the exact same time!
Regardless of which path you choose, our Freeze by Co team and medical experts will be there to guide you through the process as we work to keep your family-building options on the table.