DEAR DOCTOR K:
I have pelvic inflammatory disease, and I’m worried this could affect my fertility.
You’re right to be concerned. Pelvic inflammatory disease (PID) is the most common preventable cause of infertility in the United States. The more often a woman gets PID, the greater her risk of becoming infertile.
Most cases of PID develop from sexually transmitted diseases (STDs), usually gonorrhea or chlamydia. These two different kinds of bacteria can be passed by a man to a woman during sex. First, they infect the cervix, the part of the uterus that extends into the vagina. From there, they can move through the opening of the cervix into the uterus. Then they can enter the fallopian tubes, which carry an egg that has been released by the ovary into the uterus. The bacteria can work their way up the tubes to the ovary. (See illustration.)
Development of pelvic inflammatory disease
PID is insidious: Not all women with PID have symptoms. This is particularly true for infection with chlamydia. Those who do get symptoms may experience:
- pain in the pelvis and lower abdomen
- vaginal discharge with an unpleasant odor
- fever and chills
- nausea and vomiting
- pain during sexual intercourse
If you have symptoms that might indicate PID, it’s important to see a doctor right away. If the doctor diagnoses PID, you should begin treatment immediately.
PID is treated with antibiotics. Most cases clear up after 10 to 14 days. Finish the entire course of antibiotics, even after your symptoms go away, as the infection can still be present after the symptoms disappear. Stopping treatment early may leave you with an ongoing infection. You may not have symptoms, but the continuing infection can damage your tissues.
If your infection is more severe, you may need to be hospitalized and given antibiotics intravenously. You can relieve pain and discomfort with pain medication, hot baths and heating pads. If the infection causes an abscess, or collection of pus, you may need surgery.
PID can cause infertility by producing scarring that damages or blocks the fallopian tubes. If an egg released by the ovary can’t pass through the fallopian tubes, it can’t get to the uterus to be fertilized.
How can you prevent future attacks of PID and the infertility that it can potentially cause? If you are in a relationship with one uninfected partner, you are unlikely to be reinfected. If it’s not clear whether your sexual partner or partners are free of these infections, always use a condom during sexual intercourse to prevent another episode of PID. And make sure your sexual partners have been treated for STDs.
If you and your partner want to have kids and you are having trouble getting pregnant, see your gynecologist. You may need to have special testing to see if your tubes have been scarred by PID. If they have, there are surgical procedures that may help. Finally, in vitro fertilization can be an answer for infertility due to scarring from PID.