As part of an infertility evaluation, physicians inquire about a couples' past exposure to sexually transmitted diseases (STDs). Often times, a patient will reply, “Oh I had chlamydia once, but it was a long time ago when I was a teenager”. What happened “a long time ago” in a patient's mind, might be the red flag we are looking for to explain why pregnancy isn't happening now.
Chlamydia, and to a lesser degree Gonorrhea, is one of the biggest causes of tubal damage in women. Unfortunately, many cases of chlamydia are silent, so tubal damage may have occurred without a patient knowing.
Chlamydia is contracted through sexual intercourse. It starts by infecting the cervix, causing cervicitis. The bacteria can then travel into the uterus, causing “endometritis”, and fallopian tubes, causing “salpingitis”. The inside of the fallopian tubes are lined by delicate cilia, or hairs, that are extremely important in moving eggs, sperm, and embryos into the right locations. When a chlamydia infection occurs in the fallopian tubes, the cilia and inside of the tube may be damaged.
If the chlamydia infection goes untreated, PID (pelvic inflammatory infection) may occur. This results in scar formation in the pelvis which can block the openings of the tubes or pull them into unnatural positions. If a hydrosalpinx forms, where the tube is blocked and fills up with fluid, the fluid can drip into the uterine cavity and prevent embryos from implanting, or wash away embryos that are already there.
Tubal damage can result in failure to conceive because the tube is unable to pick up an egg from the ovary. It can also result in ectopic, or tubal pregnancies, because the dysfunctional tube is unable to adequately move the embryo into the uterus. The presence of a hydrosalpinx can decrease the success of an IVF (in vitro fertilization) cycle or increase the risk of miscarriage and must be removed surgically if present.
Tubal damage from a prior sexually transmitted infection is frequently detected by HSG (hysterosalpingogram) during an infertility evaluation. The HSG x-ray can show if a tube is blocked. It is very good at revealing a hydrosalpinx. However, even when tubes appear to be open on the HSG film, that does not guarantee that the tubes function normally.
Past infections of chlamydia can be detected with blood work. When chlamydia antibodies are present, the likelihood of a tubal problem increases.
Men's fertility is less clearly impacted by STDs than women's. Severe infections may result in scarring in the male reproductive tract blocking the pathway of sperm to come out during ejaculation. More often, though, asymptomatic infections are diagnosed at the time of the semen analysis. White blood cells may be seen in the sample, suggesting an infection is present. These white blood cells may result in excess reactive oxygen species in the semen which may impact sperm function. Antibiotics are usually given to the male partner in these situations.
Other bacteria, like Ureaplasma urealyticum and Mycoplasma hominis have not been clearly linked with infertility.
Sexually transmitted diseases are unfortunately a well-known cause of tubal factor infertility. Sadly, these diseases frequently occur in patients without them ever knowing. A standard infertility evaluation will always take into consideration the possibility of a prior exposure to an STD. A thorough history taken by your physician, along with gonorrhea and chlamydia cultures, chlamydia antibody titers, and an HSG will help determine if a patient's infertility is related to a prior STD exposure.
Robin H. Fogle, MD, fertility specialist in Atlanta, GA, joined the Atlanta Center for Reproductive Medicine in the Fall of 2007 after completing her fellowship training in Reproductive Endocrinology and Infertility at the University of Southern California Keck School of Medicine, Los Angeles, California. As a Georgia reproductive specialist, Dr. Fogle's clinical interests include in vitro fertilization, polycystic ovarian syndrome, premature ovarian failure, and reproductive surgery. Her research interests center around uterine receptivity and embryo implantation, especially in donor IVF and gestational carriers. Dr. Fogle is Board Certified in Obstetrics and Gynecology and Board Certified in Reproductive Endocrinology.
For more information, or to schedule an appointment with Dr. Fogle please call 678.3841.1089.