Pelvic Inflammatory Disease And Infertility Treatment Advances

The inflammation of a woman’s upper reproduc­tive tract, including the structures of the uterus, ovaries, and fallopian tubes is known as Pelvic inflam­matory disease (PID). Sal­pingitis, inflammation of the fallopian tubes, is the most common manifesta­tion of the disease. PID is known to be a long-term consequence of many sexu­ally transmitted diseases as well as bacterial vaginosis (BV), pelvic surgery, and other gynecologic proce­dures that cross the cervix.

It is fundamentally a pre­ventable condition.

Pelvic inflammatory dis­ease is, essentially, caused by the body overreacting to an infection. As the im­mune system tries to fight off the invading bacteria, it causes local inflammation and scarring. Although this may successfully wall off the infection inside the reproductive tract, it can damage the organs. PID can cause scarring in the uter­us, fallopian tubes, and even in the pelvic cavity. This is one of the main reasons it causes chronic pelvic pain.

The most common infec­tions associated with pelvic inflammatory disease are chlamydia and gonorrhea. Because the symptoms of PID are the result of the body’s response to the un­derlying infection, treat­ment usually involves antibiotics to treat that in­fection. In severe cases, or an emergency, surgery may be necessary to drain an ab­scess that has ruptured or threatens to rupture.

Symptoms

˜Pain in the lower abdo­men and pelvis

˜Irregular periods

˜Pain during sex

˜Pain during urination

˜Lower back pain

˜Excess vaginal dis­charge with a foul odour

˜Fever, exhaustion, diarrhea, vomiting, and other general signs of in­fection.

Is PID common?

In the early 1990s, the self-reported frequency of PID in women was approx­imately one in nine. PID was more than twice as common in women with a history of sexually trans­mitted diseases (26 percent) than among women who had never reported an STD (10 percent).

Risk factors

Younger age: Sexually experienced teenagers are three times more likely to be diagnosed with PID than their 25- to 29-year-old counterparts. Scientists do not know, however, wheth­er this is due to biological factors that make young women more susceptible to STDs or different sexual behaviors in these two age groups.

Women have the high­est risk of PID of the eth­nic groups seen in the U.S. This may be related to bi­ological fac­tors, or due to their compar­atively high frequency of douching.

C o n t r a ­c e p t i v e Choice: Bar­rier methods, such as con­doms, and oral contra­ceptives re­duce the risk of PID.

Douching: D o u c h i n g greatly increases a wom­an’s risk of PID.

Concerns about PID

Worldwide, PID is one of the leading causes of ecto­pic pregnancy and prevent­able infertility in women.

Pelvic inflammatory dis­ease can cause infertility by damaging the fallopian tubes. This damage can block the tubes, making it difficult for a fertilised egg to reach the uterus.

What duration does it take to become infertile with PID?

PID can permanently scar and damage the fallo­pian tubes, causing block­age of the tubes. About 12 percent of women suffer enough tubal damage from one episode of PID to be­come infertile. After three episodes of PID, the infertil­ity rate reaches 50 percent.

It is less expensive to pre­vent PID-related infertility than to treat the STDs and PID that cause infertility and resolve infertility in couples who wish to be­come pregnant. Ultimate­ly, the costs of preventing PID-related infertility are probably much lower. Those costs would primar­ily include those for educa­tion about safer sex, douch­ing, and condom use as well as screening and treatment for chlamydia and other STDs. Such preventive measures would probably be only a small fraction of the cost spent on treatment.

The relationship be­tween PID and infertility is relatively well-accepted. PID causes infertility by the scarring process that occurs during the healing of sexually transmitted infections. The extensive scarring can eventually oc­clude one or both fallopian tubes, and scarring tends to be worse among older women, smokers, and wom­en using IUDs. Depending on the extent of scarring it may be impossible for sperm to reach the egg, or, if sperm can get through, the fertilised egg may be unable to get to the uterus.

Not surprisingly, the per­centage of women who ex­perience infertility due to PID is directly proportional to the number of episodes of PID that they have ex­perienced. Therefore, both treating and preventing PID are important steps in the reduction of infertility.

Dr Taiwo Orebamjo is an ex­perienced Consultant Obstetri­cian and a medical administra­tion expert from the Kingston Academy of Learning and Career College Canada. He is a post-graduate of the Royal College of Obstetricians and Gynaecologists, London. The Research Fellow in assisted conception at the St. George’s Teaching Hospital in Tooting London is also the Consultant Obstetrician &Gynaecologist, Medical Director, at Parklande Specialist Hospital & Lifeshore Fertility and IVF Clinic.