Infertility following pelvic inflammatory disease

Abstract

Objective To assess the frequency of infertility after pelvic inflammatory disease (PID) and factors important in postinfectious tubal damage in an urban population at high risk for sexually transmitted diseases. Methods From a cohort of 213 women with PID documented by laparoscopy and/or endometrial biopsy, 58 women (27% of the initial cohort) were interviewed by phone 2 to 9 years after an index episode of PID. Data regarding the initial history, physical examination, microbiology, laparoscopic, and serologic findings, and data concerning interval contraception, subsequent pregnancy, subsequent infection, and chronic pelvic pain were compared among those with and without infertility at follow up. Results Nineteen (40%) of the 48 women not using contraception were involuntarily infertile after the index episode of PID. Compared with those who had an interval pregnancy, infertile women were older (P = 0.02), more likely to have a history of infertility prior to the index episode of PID (P = 0.001), and were more likely to have occluded or partially occluded fallopian tubes (P = 0.03), peritubal adhesions (P = 0.007), or perihepatic adhesions (P = 0.02) seen by laparoscopy performed during the index episode. Surprisingly, recovery of Chlamydia trachomatis was negatively related to infertility (P = 0.001), although a similar proportion of both groups had chlamydia immunoglobulin M antibody (40% vs. 31%). Chlamydia heat shock protein was weakly related to infertility (P = 0.08). The isolation of Neisseria gonorrhoeae was not significantly different between groups (53% vs. 57%). Conclusions The high rate of postinfection infertility found was probably related to a combination of tubal damage before and during the index episode of PID. Prevention of recurrent PID and better understanding of the pathophysiology of postinfection tubal damage (which may differ between chlamydia and gonorrhea) is needed to develop more effective strategies to reduce permanent tubal damage. Infect. Dis. Obstet. Gynecol. 7:145–152, 1999. © 1999 Wiley‐Liss, Inc.

Interaction of Microbiology and Pathology in Women Undergoing Investigations for Infertility

“…PID also causes tubal infertility. The severity of tubal damage occurring during PID determines the probability of infertility: 3% of women with mild tubal damage observed at laparoscopy, 13% with moderate damage, and 29% with severe damage, were identified as having tubal infertility 5 . Despite the high causal relationship between bacterial infection and PID, organisms are rarely isolated in PID cases, and even less frequently in cases of tubal infertility 6 .…”

The utility and cost of Chlamydia trachomatis and Neisseria gonorrhoeae screening of a male infertility population

“…Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most common bacterial STIs diagnosed in North America and have been associated with reproductive morbidity in men and women (1). In women, CT and NG can lead to pelvic inflammatory disease (PID) and subsequent ectopic pregnancy and tubal factor infertility (2)(3)(4). In men, NG has been linked to genitourinary tract inflammation and obstruction, and infertility (5).…”

New sexual partners and readiness to seek screening for chlamydia and gonorrhoea: predictors among minority young women

“…[1][2][3][4][5] In addition, early detection through screening, along with treatment, could decrease the duration of infection that, in turn, may reduce the risk of transmission to other sex partners.…”

“…[1][2][3] Early detection through screening and treatment of both asymptomatic and symptomatic CT and NGC infections is important to decrease the duration of untreated infection and thereby decrease the incidence of PID and minimise tubal damage. [1][2][3][4][5] In addition, early detection through screening, along with treatment, could decrease the duration of infection that, in turn, may reduce the risk of transmission to other sex partners.…”