Key points of pelvic inflammatory disease (PID) & infertility
- Pelvic inflammatory disease (PID) is an infection of the upper female reproductive organs including the uterus, fallopian tubes and ovaries.
- PID mainly causes infertility through a buildup of scar tissue or abscesses that damage the fallopian tubes or ovaries, preventing fertilization or implantation.
- Pelvic inflammatory disease is primarily caused by the sexually transmitted diseases of gonorrhea and chlamydia, though other vaginal bacteria issues can also cause it.
- Symptoms can be absent or mild and include pain in the pelvic area, unusual vaginal discharge, irregular periods, nausea and vomiting.
- Treatments for PID are mostly antibiotics to stop the bacterial infection, with hospitalization and surgery options in severe cases.
- IVF (in vitro fertilization) is the primary fertility treatment to overcome the infertility PID can cause, with tubal surgery also a prospect.
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What is pelvic inflammatory disease (PID)?
Pelvic inflammatory disease (PID) is a syndrome causing inflammation of the fallopian tubes, ovaries, the endometrium (uterine lining) or the peritoneum, which is the membrane covering the abdominal organs. Pelvic inflammatory disease results in serious infection affecting a woman’s upper reproductive organs.
It is relatively common, with the National Institutes of Health reporting that about 800,000 women in the United States get PID each year. However, health experts say that this disease is under-reported. One reason is that many women experience no symptoms, mild symptoms or symptoms that are also associated with other conditions.
It is caused by infections – primarily sexually transmitted infections (STIs) – travelling from the vagina to the reproductive organs.
Can pelvic inflammatory disease cause infertility?
Yes, it can. In fact, 1 in 10 women with PID experience infertility, according to the American College of Obstetricians and Gynecologists (ACOG). PID is a leading cause of tubal factor infertility and ectopic pregnancy.
Chronic pelvic pain and fertility
Aside from causing infertility in women, this disease can result in long-term chronic pelvic pain. While this is uncomfortable and debilitating, chronic pelvic pain often causes a marked decrease in a woman’s sexual desire and causes her to avoid having sex. This can have a strong, indirect effect on fertility.
Damage to reproductive organs, including the fallopian tubes
Severe cases of the disease can permanently damage reproductive organs through scar tissue and abscesses (pockets of infected fluid) in the ovaries and fallopian tubes. Scarring in the fallopian tubes is a leading cause of PID-related infertility.
This can cause blockages in the fallopian tubes that prevent sperm from traveling to the egg for fertilization. It can also prevent a fertilized egg in the fallopian tube from traveling to the uterus for implantation.
Pelvic inflammatory disease and ectopic pregnancy
Scarring in the tubes also causes ectopic pregnancy because scar tissue blocks the fertilized egg from reaching the uterus. This causes the fertilized egg to attach outside the uterus, which is a dangerous situation for the woman and an unviable pregnancy that must be ended.
Having an ectopic pregnancy increases one’s chance of having another. Ectopic pregnancy can also damage the fallopian tubes, causing infertility.
PID symptoms
Knowing the symptoms of PID is very important for all women, and particularly so for those trying to conceive, either naturally or with fertility treatments. That’s because the longer PID is left untreated, the more severe the damage to pelvic organs and one’s fertility can be – including irreversible damage.
Common signs and PID symptoms
Many times, women with pelvic inflammatory disease don’t know they have it because symptoms can be absent or mild. But PID symptoms can come on fast. The most common ones include:
- Pain in the lower abdomen and pelvic area.
- Pain during sexual intercourse.
- Chills or fever.
- Nausea and vomiting.
- Unusual vaginal discharge that can smell bad and be green or yellow.
- Burning sensation with urination, and more frequent urination.
- Irregular periods or bleeding between periods.
- Trouble conceiving.
We advise women experiencing these symptoms to see their doctor to determine their cause, even if symptoms are mild. Some symptoms can indicate an STI, which can lead to PID. Untreated PID can cause permanent damage to the reproductive system.
When to seek immediate medical care
Do not hesitate to seek medical care right away if PID symptoms cause you to experience:
- Temperature above 101° Fahrenheit.
- Intense pain in the pelvic area.
- Vomiting and upset stomach.
Pelvic inflammatory disease causes
Bacteria entering the pelvic area and reproductive tract causes PID, with sexually transmitted diseases (STDs) being the main source of the infecting bacteria (see more below). Bacteria present in the vagina travels to the uterus, fallopian tubes or ovaries, infecting those organs.
Most of the time the cervix prevents infections from reaching these organs. But infections can affect the cervix, preventing it from stopping additional infections from moving further into the woman’s body.
How bacterial vaginosis and other vaginal bacteria cause PID
Bacterial vaginosis, which is an imbalance of bacteria in the vagina, can also cause pelvic inflammatory disease. Other types of vaginal bacteria that can travel past the cervix to cause the disease result from the following:
- Pelvic surgery.
- Miscarriage.
- Having an IUD, with risk mostly in the first few weeks after insertion.
Sexually transmitted diseases (STDs) cause PID
PID cases are due primarily to STDs and STIs, most commonly gonorrhea and chlamydia. Because of this elemental cause, PID is often spread through unprotected sex.
The male can get the STD from his female partner then spread it to another female sexual partner. Men do not get pelvic inflammatory disease; they are only carriers of it.
Women with gonorrhea or chlamydia who do not receive treatment can develop PID in a few days after contracting it or a few weeks, according to ACOG.
Women ages 15-25, who are generally the most sexually active, are most likely to get PID. Chlamydia and gonorrhea are thought to cause about 90% of PID cases.
Risks for contracting PID
- Women with an STI or STD, particularly gonorrhea and chlamydia.
- Having sex without a condom.
- Sexually active women under age 25.
- Those who have sex with multiple partners or have a partner who has sex with multiple partners.
- Those who’ve had a PID previously.
- Douching, which can result in vaginal bacteria being pushed through the cervix and is not recommended, according to the Office on Women’s Health.
- Women who have had a tubal ligation or other pelvic surgeries.
PID diagnosis
There isn’t one specific test for pelvic inflammatory disease, and a doctor or fertility specialist diagnoses the disease through a combination of examinations, tests, and discussions of health history and symptoms.
Diagnostic tests
The physician will conduct a bimanual (using both hands) physical exam to evaluate the pelvic organs, gauge tenderness and feel for abscesses. Other tests include:
- Vaginal culture to test for bacteria.
- Blood tests, urine tests and ultrasound.
- Specific test for STIs.
- Occasionally, endometrial biopsy or laparoscopy, to better examine organs.
PID treatment
Starting medication fast is key to treating PID. This helps reduce discomfort and the chance of PID resulting in infertility.
Antibiotics are the primary treatment for this disease to end the bacterial infection. A combination of antibiotics may be the first step a doctor takes. Blood tests can indicate what particular bacteria is causing the infection, and antibiotics may be adjusted accordingly.
- Hospitalization may be needed in cases of pregnancy, severe illness, presence of an abscess or if antibiotics are not working.
- In some cases surgery is needed, most likely if an abscess ruptures or if illness continues without improvement with antibiotics.
- Another part of treatment for PID is not having sex until treatment is working and symptoms are gone.
- Testing and treating the male partner for an STD is part of treating the woman’s pelvic inflammatory disease.
We can cure the disease, but we cannot undo the damage it has done to the reproductive organs. For those trying to conceive with PID-related infertility, fertility treatments are necessary.
Fertility treatments for PID-related infertility
IVF is the preferred treatment
Because of the damage to the fallopian tubes caused by the disease, IVF (in vitro fertilization) is the preferred treatment, and the most successful for PID-related infertility.
Laparoscopic tubal surgery is an option that can unblock fallopian tubes. It can also remove damaged tubes before IVF.
Pelvic inflammatory disease prevention
Not getting an STI is the best prevention against PID. Prevent gonorrhea and chlamydia by taking these steps.
- Always use a condom or barrier method of birth control correctly every time you have sex (not a viable option for those trying to conceive).
- Limit sex partners.
Other conditions such as bacterial vaginosis can cause PID. The best practice to prevent those from causing the disease is to seek treatment for symptoms right away, avoid douching, and get regular gynecologic checkups and screenings.
