Subclinical pelvic inflammatory disease and infertility
Harold C Wiesenfeld1, Sharon L Hillier, Leslie A Meyn
1Departments of Obstetrics, Gynecology and Reproductive Sciences and Pathology, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. hwiesenfeld@mail.magee.edu
Obstetrics and Gynecology
|June 9, 2012
Summary
Subclinical pelvic inflammatory disease (PID) significantly reduces fertility in women, even after treatment for sexually transmitted infections. This highlights the need for better diagnostic and therapeutic strategies to prevent infertility.
Area of Science:
- Reproductive Health
- Infectious Diseases
- Gynecology
Background:
- Reported acute pelvic inflammatory disease (PID) rates have declined, yet tubal infertility rates remain high.
- This suggests undetected PID contributes significantly to infertility.
- Subclinical PID is prevalent in women with cervicitis or bacterial vaginosis.
Purpose of the Study:
- To investigate the association between subclinical PID and infertility risk.
- To determine if subclinical PID impacts subsequent fertility outcomes.
Main Methods:
- A prospective observational cohort study of 418 women at risk for STIs or with bacterial vaginosis.
- Endometrial biopsy used to diagnose subclinical PID (endometritis).
- Follow-up for fertility outcomes after STI/BV treatment.
Main Results:
- Women with subclinical PID had a 40% lower pregnancy incidence (HR 0.6).
- 50 pregnancies occurred in 120 women (42%) with subclinical PID vs. 96 in 187 (51%) without.
- Neisseria gonorrhoeae or Chlamydia trachomatis alone, without subclinical PID, did not increase infertility risk.
Conclusions:
- Subclinical PID independently reduces female fertility.
- Current STI treatments are insufficient to prevent infertility caused by subclinical PID.
- A significant portion of female infertility may be linked to undetected subclinical PID.
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