A sexually transmitted disease—past or present—can affect your fertility. But being honest with your doctor can help detect problems early, and put you on the right path to getting pregnant.
Health experts have new reason to bring sexually transmitted diseases (STDs) “out of the closet,” so to speak: These illnesses—including chlamydia, gonorrhea, herpes, syphilis and others—are responsible for roughly one-fourth of infertility cases. And they are anything but rare. While doctors report 20 million cases each year, the actual numbers are thought to be much higher, since so many go undiagnosed and untreated because they cause no symptoms at all—so-called “silent” cases. In fact, difficulty getting pregnant may be the first warning sign that something is wrong.
Embarrassment may previously have kept some patients—and doctors—from bringing up the subject, but the Centers for Disease Control and Prevention (CDC) recently recommended that every woman planning to get pregnant be tested for chlamydia and gonorrhea—the biggest fertility threats—at her preconception checkup, and that physicians order other tests depending on a couple’s sexual history. Another sign of the medical profession’s new attitude: Health professionals are being urged to substitute the initials STI, for sexually transmitted infections, for the old acronym STD, in the hope that the word infection will sound less scary than the word disease.
If numbers tell a story, the time for being coy about the subject is long past: “Fifty percent of the population will acquire an STD by age 35,” says Spencer Richlin, MD, reproductive endocrinologist with Reproductive Medicine Associates of Connecticut.
Not all STDs directly affect the ability to get pregnant. While chlamydia and gonorrhea are of great concern when it comes to fertility and conception, experts agree that other sexually transmitted infections—herpes, human papilloma virus (HPV or genital warts), hepatitis B, syphilis, trichomonas vaginalis (a parasite), crabs (pubic lice), and HIV—do not directly affect fertility, although advanced infections and side effects from treatments may cause problems. For instance, if HPV progresses to cancerous lesions on the cervix, “the treatment, particularly cone biopsies, can sometimes damage the cervical mucus glands,” leading to infertility, says Dr. Potter (although these pre-cancerous changes on their own do not have an impact on fertility).
If you or your current partner has been diagnosed with any STD in the past, you should discuss it openly with your physicians—gynecologist, endocrinologist, or urologist—so the doctor can assess any effect on fertility. Having contracted one STD increases your risk of being vulnerable to another, so your doctor may want to do tests to be sure before you try to get pregnant.
How Trouble Spreads
Usually, it is not the STD itself that causes infertility, but the spread of inflammation resulting from the original infection. Women under age 24 are at the highest risk of contracting STDs, since the cervix is not fully matured and infections are more easily passed through; this is also the age at which multiple partners are most common. The so-called “silent” cases—those that go unnoticed and untreated—are the biggest fertility threats, since the damage they cause can go unchecked.
In women, this damage is often pelvic inflammatory disease (PID), an infection of the uterus, fallopian tubes, or other reproductive organs that can develop as a result of chlamydia or gonorrhea—the two most common bacterial STDs and those most likely to be silent. PID can result in scarring of the fallopian tubes, making it difficult or impossible for eggs to move through them and resulting in an inability to conceive. According to the CDC, more than 1 million women each year contract PID, and 100,000 of those women become infertile because of it.
The American Social Health Association reports that 15 percent of women who are infertile can attribute it to tubal damage caused by pelvic inflammatory disease from an untreated STD. The more PID episodes a woman has had, the greater her risk of infertility. Robert Straub, MD, of Reproductive Biology Associates in Atlanta, says, “It has been estimated that PID causes tubal disease leading to infertility at the following rates: one episode: 15 percent, two episodes: 35 percent, and three episodes: 75 percent.” Ectopic pregnancy, a potentially life-threatening situation in which the egg implants in the fallopian tube instead of in the uterus, is another concern; nine percent of women who have PID caused by chlamydia will experience ectopic pregnancy.