Analysis of cytomorphologic alterations noted in Pap test smears in women with infertility: An institutional experience

INTRODUCTION: Infertility is a growing global health concern, affecting 60-80 million couples worldwide, of which 15-20 million are in India. Cervical health plays a pivotal role in reproduction, acting as both a barrier to infection and a facilitator of fertilization. Pap smear test (PST), though traditionally used for cervical cancer screening, may provide valuable insights into cervical pathology, infections, and microenvironmental changes associated with infertility. The aim and objectives of the present study are to evaluate cytomorphological alterations on PST in women with infertility and assess their role in identifying reversible causes affecting fertility. MATERIALS AND METHODS: An ambispective study was conducted in the Department of Pathology and Laboratory Medicine at AIIMS Kalyani over three years (July 2022-June 2025). Women with primary or secondary infertility were included. PST were prepared using both conventional and liquid-based cytology, stained as per standard protocols, and reported using the Bethesda System for reporting cervical cytology (2014). Clinical and demographic data were recorded, and statistical analysis was applied to evaluate findings. RESULT: A total of 241 infertile women underwent PST. Of these, 204 (84.6%) had primary infertility and 37 (15.3%) had secondary infertility. Inflammation was detected in 234 cases (97.1%), ranging from mild (58.8%) to severe (9.1%). Significant PST changes were observed in 153 (63.5%) cases, including moderate to severe inflammation, infections, and epithelial abnormalities. Infectious aetiologies included bacterial vaginosis (24.5%), Candidiasis (5.4%), and Trichomoniasis (0.8%). Lactobacilli depletion was noted in 28% of cases. Epithelial abnormalities were rare, with one case of Low-grade Squamous intraepithelial lesion (LSIL) and one case of Atypical squamous cells of undetermined significance (ASC-US). CONCLUSION: PST, being simple, cost-effective, and widely accessible, is a valuable tool for identifying reversible causes of infertility such as infections, inflammation, and altered microbiota. Incorporating PST into routine infertility workup may facilitate timely diagnosis and management, ultimately improving reproductive outcomes.