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. 1999;7(3):145–152. doi: 10.1002/(SICI)1098-0997(1999)7:3<145::AID-IDOG6>3.0.CO;2-6

Infertility following pelvic inflammatory disease.

A J Pavletic 1, P Wölner-Hanssen 1, J Paavonen 1, S E Hawes 1, D A Eschenbach 1
PMCID: PMC1784727  PMID: 10371473

Abstract

OBJECTIVE: To assess the frequency of infertility after pelvic inflammatory disease (PID) and factors important in postinfectious tubal damage in an urban population at high risk for sexually transmitted diseases. METHODS: From a cohort of 213 women with PID documented by laparoscopy and/or endometrial biopsy, 58 women (27% of the initial cohort) were interviewed by phone 2 to 9 years after an index episode of PID. Data regarding the initial history, physical examination, microbiology, laparoscopic, and serologic findings, and data concerning interval contraception, subsequent pregnancy, subsequent infection, and chronic pelvic pain were compared among those with and without infertility at follow up. RESULTS: Nineteen (40%) of the 48 women not using contraception were involuntarily infertile after the index episode of PID. Compared with those who had an interval pregnancy, infertile women were older (P = 0.02), more likely to have a history of infertility prior to the index episode of PID (P = 0.001), and were more likely to have occluded or partially occluded fallopian tubes (P = 0.03), peritubal adhesions (P = 0.007), or perihepatic adhesions (P = 0.02) seen by laparoscopy performed during the index episode. Surprisingly, recovery of Chlamydia trachomatis was negatively related to infertility (P = 0.001), although a similar proportion of both groups had chlamydia immunoglobulin M antibody (40% vs. 31%). Chlamydia heat shock protein was weakly related to infertility (P = 0.08). The isolation of Neisseria gonorrhoeae was not significantly different between groups (53% vs. 57%). CONCLUSIONS: The high rate of postinfection infertility found was probably related to a combination of tubal damage before and during the index episode of PID. Prevention of recurrent PID and better understanding of the pathophysiology of postinfection tubal damage (which may differ between chlamydia and gonorrhea) is needed to develop more effective strategies to reduce permanent tubal damage.

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Selected References

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  1. Brihmer C., Kallings I., Nord C. E., Brundin J. Second look laparoscopy; evaluation of two different antibiotic regimens after treatment of acute salpingitis. Eur J Obstet Gynecol Reprod Biol. 1989 Mar;30(3):263–274. doi: 10.1016/0028-2243(89)90011-7. [DOI] [PubMed] [Google Scholar]
  2. Brunham R. C., Binns B., Guijon F., Danforth D., Kosseim M. L., Rand F., McDowell J., Rayner E. Etiology and outcome of acute pelvic inflammatory disease. J Infect Dis. 1988 Sep;158(3):510–517. doi: 10.1093/infdis/158.3.510. [DOI] [PubMed] [Google Scholar]
  3. Brunham R. C., Peeling R., Maclean I., Kosseim M. L., Paraskevas M. Chlamydia trachomatis-associated ectopic pregnancy: serologic and histologic correlates. J Infect Dis. 1992 Jun;165(6):1076–1081. doi: 10.1093/infdis/165.6.1076. [DOI] [PubMed] [Google Scholar]
  4. Cates W., Jr, Wasserheit J. N. Genital chlamydial infections: epidemiology and reproductive sequelae. Am J Obstet Gynecol. 1991 Jun;164(6 Pt 2):1771–1781. doi: 10.1016/0002-9378(91)90559-a. [DOI] [PubMed] [Google Scholar]
  5. Eckert L. O., Hawes S. E., Wölner-Hanssen P., Money D. M., Peeling R. W., Brunham R. C., Stevens C. E., Eschenbach D. A., Stamm W. E. Prevalence and correlates of antibody to chlamydial heat shock protein in women attending sexually transmitted disease clinics and women with confirmed pelvic inflammatory disease. J Infect Dis. 1997 Jun;175(6):1453–1458. doi: 10.1086/516479. [DOI] [PubMed] [Google Scholar]
  6. Falk V. Treatment of acute non-tuberculous salpingitis with antibiotics alone and in combination with glucocorticoids. A prospective double blind controlled study of the clinical course and prognosis. Acta Obstet Gynecol Scand. 1965;44(Suppl):3–118. doi: 10.3109/00016346509158538. [DOI] [PubMed] [Google Scholar]
  7. Jacobson L., Weström L. Objectivized diagnosis of acute pelvic inflammatory disease. Diagnostic and prognostic value of routine laparoscopy. Am J Obstet Gynecol. 1969 Dec 1;105(7):1088–1098. doi: 10.1016/0002-9378(69)90132-x. [DOI] [PubMed] [Google Scholar]
  8. Jones R. B., Ardery B. R., Hui S. L., Cleary R. E. Correlation between serum antichlamydial antibodies and tubal factor as a cause of infertility. Fertil Steril. 1982 Nov;38(5):553–558. doi: 10.1016/s0015-0282(16)46634-3. [DOI] [PubMed] [Google Scholar]
  9. Kimani J., Maclean I. W., Bwayo J. J., MacDonald K., Oyugi J., Maitha G. M., Peeling R. W., Cheang M., Nagelkerke N. J., Plummer F. A. Risk factors for Chlamydia trachomatis pelvic inflammatory disease among sex workers in Nairobi, Kenya. J Infect Dis. 1996 Jun;173(6):1437–1444. doi: 10.1093/infdis/173.6.1437. [DOI] [PubMed] [Google Scholar]
  10. Kiviat N. B., Wølner-Hanssen P., Eschenbach D. A., Wasserheit J. N., Paavonen J. A., Bell T. A., Critchlow C. W., Stamm W. E., Moore D. E., Holmes K. K. Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis. Am J Surg Pathol. 1990 Feb;14(2):167–175. doi: 10.1097/00000478-199002000-00008. [DOI] [PubMed] [Google Scholar]
  11. Miettinen A., Heinonen P. K., Teisala K., Hakkarainen K., Punnonen R. Serologic evidence for the role of Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma hominis in the etiology of tubal factor infertility and ectopic pregnancy. Sex Transm Dis. 1990 Jan-Mar;17(1):10–14. [PubMed] [Google Scholar]
  12. Money D. M., Hawes S. E., Eschenbach D. A., Peeling R. W., Brunham R., Wölner-Hanssen P., Stamm W. E. Antibodies to the chlamydial 60 kd heat-shock protein are associated with laparoscopically confirmed perihepatitis. Am J Obstet Gynecol. 1997 Apr;176(4):870–877. doi: 10.1016/s0002-9378(97)70613-6. [DOI] [PubMed] [Google Scholar]
  13. Moore D. E., Spadoni L. R., Foy H. M., Wang S. P., Daling J. R., Kuo C. C., Grayston J. T., Eschenbach D. A. Increased frequency of serum antibodies to Chlamydia trachomatis in infertility due to distal tubal disease. Lancet. 1982 Sep 11;2(8298):574–577. doi: 10.1016/s0140-6736(82)90659-6. [DOI] [PubMed] [Google Scholar]
  14. Paavonen J., Vesterinen E., Aantaa K., Räsänen J. Factors predicting abnormal hysterosalpingographic findings in patients treated for acute pelvic inflammatory disease. Int J Gynaecol Obstet. 1985 Jun;23(3):171–175. doi: 10.1016/0020-7292(85)90100-6. [DOI] [PubMed] [Google Scholar]
  15. Patton D. L., Askienazy-Elbhar M., Henry-Suchet J., Campbell L. A., Cappuccio A., Tannous W., Wang S. P., Kuo C. C. Detection of Chlamydia trachomatis in fallopian tube tissue in women with postinfectious tubal infertility. Am J Obstet Gynecol. 1994 Jul;171(1):95–101. doi: 10.1016/s0002-9378(94)70084-2. [DOI] [PubMed] [Google Scholar]
  16. Patton D. L., Kuo C. C., Wang S. P., Halbert S. A. Distal tubal obstruction induced by repeated Chlamydia trachomatis salpingeal infections in pig-tailed macaques. J Infect Dis. 1987 Jun;155(6):1292–1299. doi: 10.1093/infdis/155.6.1292. [DOI] [PubMed] [Google Scholar]
  17. Safrin S., Schachter J., Dahrouge D., Sweet R. L. Long-term sequelae of acute pelvic inflammatory disease. A retrospective cohort study. Am J Obstet Gynecol. 1992 Apr;166(4):1300–1305. doi: 10.1016/s0002-9378(11)90626-7. [DOI] [PubMed] [Google Scholar]
  18. Soper D. E., Brockwell N. J., Dalton H. P. Microbial etiology of urban emergency department acute salpingitis: treatment with ofloxacin. Am J Obstet Gynecol. 1992 Sep;167(3):653–660. doi: 10.1016/s0002-9378(11)91566-x. [DOI] [PubMed] [Google Scholar]
  19. Svensson L., Mårdh P. A., Weström L. Infertility after acute salpingitis with special reference to Chlamydia trachomatis. Fertil Steril. 1983 Sep;40(3):322–329. doi: 10.1016/s0015-0282(16)47294-8. [DOI] [PubMed] [Google Scholar]
  20. Toye B., Laferrière C., Claman P., Jessamine P., Peeling R. Association between antibody to the chlamydial heat-shock protein and tubal infertility. J Infect Dis. 1993 Nov;168(5):1236–1240. doi: 10.1093/infdis/168.5.1236. [DOI] [PubMed] [Google Scholar]
  21. Tubal infertility: serologic relationship to past chlamydial and gonococcal infection. World Health Organization Task Force on the Prevention and Management of Infertility. Sex Transm Dis. 1995 Mar-Apr;22(2):71–77. [PubMed] [Google Scholar]
  22. Wasserheit J. N., Bell T. A., Kiviat N. B., Wølner-Hanssen P., Zabriskie V., Kirby B. D., Prince E. C., Holmes K. K., Stamm W. E., Eschenbach D. A. Microbial causes of proven pelvic inflammatory disease and efficacy of clindamycin and tobramycin. Ann Intern Med. 1986 Feb;104(2):187–193. doi: 10.7326/0003-4819-104-2-187. [DOI] [PubMed] [Google Scholar]
  23. Weström L., Joesoef R., Reynolds G., Hagdu A., Thompson S. E. Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis. 1992 Jul-Aug;19(4):185–192. [PubMed] [Google Scholar]

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