LSIL itself does not directly prevent you from getting pregnant. A low-grade squamous intraepithelial lesion is a mild cervical cell change, usually caused by HPV, and it has no known mechanism that blocks conception. The real fertility considerations come from two related factors: the treatments sometimes used for cervical abnormalities, and the underlying HPV infection that caused the LSIL in the first place.
LSIL Usually Resolves on Its Own
Most LSIL clears without any intervention. In a study of young women, 61% of LSIL cases regressed within 12 months, and 91% resolved within 36 months. Because of these high regression rates, the standard approach for LSIL in reproductive-age women is observation with repeat screening rather than immediate treatment. This watch-and-wait strategy is important for fertility because it avoids surgical procedures on the cervix entirely.
If your Pap smear came back showing LSIL, there’s a strong chance your body will clear the abnormal cells on its own. Your provider will likely recommend follow-up screening in one to three years rather than rushing to treatment.
How Cervical Treatments Can Affect Fertility
When LSIL doesn’t resolve or progresses to a higher-grade lesion, procedures like LEEP (loop electrosurgical excision) or cone biopsy may be needed. These treatments remove a small portion of cervical tissue, and that’s where fertility can be affected in a few specific ways.
The cervix contains mucus-producing glands that play a direct role in conception. These glands filter, capture, and store sperm, then help transport it from the vagina into the uterus. Even shallow excisional procedures remove some of this tissue, particularly from the lower portion of the cervix where mucus-producing cells are most concentrated. The loss of these glands can change the quality, quantity, and composition of cervical mucus, potentially making it harder for sperm to reach the egg. One case-control study found a roughly twofold increase in infertility risk for women after cervical treatment compared to untreated women, while other larger studies found no significant effect. The evidence is mixed, but some women do report longer time to conception after cervical surgery.
The more tissue removed, the greater the potential impact. Cold knife cone biopsies that cut 25 mm or more of cervical height carried eight times the risk of preterm delivery compared to the general population. Shallower procedures carry substantially less risk.
Pregnancy Risks After LEEP or Cone Biopsy
Even when conception isn’t a problem, cervical procedures can affect how a pregnancy progresses. The main concern is preterm birth. A large meta-analysis found that women with a history of LEEP had an 8.8% rate of delivery before 37 weeks, compared to 5.1% in women without that history. The risk of very early preterm birth (before 34 weeks) was also elevated: 2.9% versus 2.3%.
Premature rupture of membranes, where the water breaks too early, occurred in 5.1% of women with prior LEEP compared to 2.5% of those without. For cold knife cone biopsy specifically, the numbers were even more pronounced. Premature rupture of membranes occurred in 27% of the cone biopsy group versus 20.5% of controls, and preterm delivery rates were 10.5% versus 4.5%.
An important nuance: when researchers compared women who had LEEP to women who also had cervical dysplasia but were never treated surgically, the preterm birth risk was essentially the same. This suggests that the cervical abnormality itself, not just the surgery, may contribute to some of the pregnancy risk.
Timing Matters
If you’ve had a LEEP or cone biopsy, waiting to conceive gives the cervix time to heal. Johns Hopkins Medicine recommends waiting at least six months before trying to get pregnant, since full cervical recovery takes about that long. Research on cone biopsy supports this: women who conceived within six months of surgery had a 40% rate of premature rupture of membranes, compared to 20% for those who waited more than a year.
During pregnancy after cervical treatment, cervical length is typically monitored in the second trimester. Women with a cervical length under 15 mm who had wider tissue removal showed a significantly increased risk of preterm delivery.
The HPV Connection
LSIL is almost always caused by HPV, and the virus itself may play a role in fertility beyond the cervical changes it produces. The research here is still developing, but some findings are worth knowing.
HPV-positive women were six times less likely to become pregnant after intrauterine insemination in one study. Other research found that HPV detected at the time of IVF was associated with lower pregnancy rates and a higher risk of early pregnancy loss. These findings don’t necessarily mean HPV prevents natural conception, but they suggest the virus may influence reproductive outcomes in ways that go beyond cervical cell changes.
If your male partner also has HPV, that adds another layer. A systematic review and meta-analysis found that sperm motility was significantly lower in HPV-positive men. Women inseminated with HPV-positive sperm had four times fewer clinical pregnancies. HPV in sperm was also strongly correlated with higher rates of pregnancy loss. Since HPV passes between partners, both of you may carry the virus even if only one has symptoms or an abnormal screening result.
What This Means for Your Plans
If you have LSIL and want to have children, the outlook is reassuring. The lesion itself doesn’t impair your ability to conceive. Most cases resolve without treatment, especially in younger women, so you may never need a procedure at all. If you do need treatment, the procedures used for low-grade lesions are typically minor, removing small amounts of tissue that pose only a modest increase in pregnancy complications.
The practical steps are straightforward. Keep up with your follow-up screening so any progression is caught early and treated conservatively. If you need a LEEP or similar procedure, plan to wait at least six months before trying to conceive. And if you’re having difficulty getting pregnant after cervical treatment, it’s worth mentioning your surgical history to a fertility specialist, since changes to cervical mucus production can sometimes be a contributing factor that’s easy to overlook.