What is the relationship between female reproductive tract infections and infertility?

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Answered by: Ruth Divine, An Expert in the Infertility: Causes Category
Infertility, defined as the inability to conceive after a year of regular and unprotected sexual intercourse, affects as many as 10% of couples worldwide. Infertility can be a big challenge to a woman, particularly if her so-called biological clock is ticking. Damage to the fallopian tubes is a major infertility factor and affects as many as 25% of infertile couples. Female reproductive tract infections are known to cause infertility by damaging the tubes and preventing the fertilization of a woman's ovum.Normally, during unprotected intercourse, the man’s sperm cells ascend through the cervix and uterus until they reach the fallopian tubes. A single sperm cell usually fuses with an egg cell at the widest part of the fallopian tube called ampulla. Upon fertilization, the fertilized ovum then travels down to the uterus, where it implants and grows into a baby.

Unfortunately, when the fallopian tube is blocked, the sperm cell cannot meet the egg cell. Blockage of a single fallopian tube can significantly decrease the chances of pregnancy. Several sexually transmitted reproductive tract infections are notorious for causing blockages in the fallopian tubes. These infections include gonorrheal infections and chlamydial infections.Gonorrhea is caused by an organism called Neisseria gonorrheae while Chlamydia is caused by an organism called Chlamydia trachomatis. Both organisms can infect the cervix, leading to the production of mucopurulent or pus-like discharge. However, these infections sometimes do not cause symptoms or are asymptomatic. If they are not treated properly and immediately, they can ascend to the upper parts of the reproductive system and cause infertility.

When gonorrheal or chlamydial infections ascend to the uterus, ovaries and fallopian tubes, a serious condition called Pelvic Inflammatory Disease or PID occurs. It is characterized by abdominal or pelvic pain, a foul-smelling yellowish vaginal discharge, fever, pain on sexual intercourse, and pain on urination. Because the body reacts to infection and inflammation with scar formation, significant scarring can occur in the fallopian tubes, with consequent infertility. This is the reason why infertility evaluation includes a detailed sexual history.

Reproductive tract infections that are not sexually transmitted can also cause infertility. For instance, the causative organism of tuberculosis called Mycobacterium tuberculosis can also affect the fallopian tubes, leading to fibrosis and narrowing or complete obstruction of the tubal lumen. On rare occasions, the normal flora of the vagina or cervix may also travel to the upper reproductive organs and cause PID and infertility.

In general, early and appropriate medical intervention can prevent female reproductive tract infections from causing infertility. Medical treatment involves the administration of antibiotics. For gonorrhea, cefuroxime may be administered orally or intramuscularly. For Chlamydia, azithromycin or doxycycline may be taken orally. For tuberculous infection of the fallopian tubes, the usual anti-tuberculosis regimen, inclusive of isoniazid, pyrazinamide, ethambutol, and rifampicin, is usually given.

If significant scarring due to infection has occurred, surgical intervention may be necessary. Tubal surgery, tuboplasty or salpinostomy may be used to address the scarring and the resultant infertility. Exploratory laparoscopy or laparotomy may be required. Nowadays, with big advancements in artificial reproductive technologies, in vitro fertilization is now preferred by couples suffering from infertility due to tubal infection and scarring. This procedure has the advantages of being minimally invasive, with relatively immediate results.

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