Who’s at Risk for STD-Related Infertility?
Chlamydia is considered the greatest risk to fertility of all the sexually transmitted infections, in part because it is so often silent. According to the CDC, 75 percent of women and 50 percent of men with chlamydia have absolutely no symptoms, and up to 40 percent of untreated chlamydia infections lead to PID in women. Recently, however, new studies have led scientists to downgrade the risk a bit. “Chlamydia has been shown to be less often associated with severe pelvic infections than previously thought, occurring in about 5 percent of women who are found to have a positive culture,” reports Carolyn Kaplan, MD, reproductive endocrinologist and director of in vitro fertilization for Georgia Reproductive Specialists and assistant clinical professor at Emory University School of Medicine in Atlanta.
Up to 20 percent of infertile couples have been exposed to chlamydia, which is spread by oral, anal, and vaginal intercourse, so even women who have always used barrier birth control could have contracted the infection. Gonorrhea can also be silent, and 20 to 25 percent of women infected with gonorrhea will contract PID.
Every woman should be aware of the symptoms of STDs, which include vaginal discharge, burning, itching, painful urination, and bleeding between periods. If you have experienced any of these symptoms, you need to tell your physician as the cause may have been an undiagnosed infection. “If a woman has a history of PID, she should seek out a fertility evaluation earlier than one would normally,” recommends Daniel Potter, MD, practice director of Huntington Reproductive Center Medical Group in California, and author of What To Do When You Can’t Get Pregnant (Marlowe & Company, 2005).
STD testing should be a part of any infertility workup. “Women are tested with a direct cervical culture. A blood test can identify antibodies indicating the woman had chlamydia in the past. There is no test to determine if a woman had gonorrhea in the past,” says Serena Chen, MD, a reproductive endocrinologist with Saint Barnabus Institute for Reproductive Medicine and Science in Livingston, New Jersey. “Many gynecologists routinely check for chlamydia at annual exams, especially for younger women who are more likely to have more partners.”
If you’re having fertility problems as a result of chlamydia, gonorrhea, or PID, it’s likely your physician will recommend a hysterosalpingogram (HSG), often called a dye test, in which dye is sent through your uterus and fallopian tubes, which are then x-rayed to look for blockage or scarring.
If testing shows that tubes are blocked, “IVF is the best option for conception,” explains Dr. Richlin. “Some physicians opt to do a laparoscopy to diagnose tubal disease and adhesions from a prior infection, with the option to reopen the fallopian tubes and remove any scar tissue.” Additionally, women who have a history of an STD “should have ultrasounds early in pregnancy to rule out tubal pregnancy,” recommends Dr. Potter.
STDs, Men and Fertility
STDs don’t seem to have a major impact on male fertility—there aren’t even any statistics available at this point—but they can be of big concern to a man’s partner, as the biological reality is that most infections are spread most easily from males to females. Longer term, undiagnosed infections can cause trouble: Chlamydia and gonorrhea may have no symptoms in men and can cause inflammation and scarring of the urethra, prostate, and epididymus (tubes that deliver sperm from the testicles to the penis). Direct exposure of developing sperm to the infection can alter and impair their functioning. If a man has had painful testes, painful urination, itching, or discharge, he should tell his physician about the symptoms since they may be caused by an undiagnosed STD. Dr. Chen notes that “when a couple is beginning their fertility workup, it is considered standard to look at a man’s sperm for evidence of infection.”
A verison of this article originally appeared in the Winter 2006 issue of Conceive Magazine.
Related Topics: Fertility Nutrition; Fertility Threats; Stress and Fertility