Infertility Following Pelvic Inflammatory Disease

[摘要] Objective:To assess the frequency of infertility after pelvic inflammatory disease (PID) and factorsimportant in postinfectious tubal damage in an urban population at high risk for sexually transmitteddiseases.Methods:From a cohort of 213 women with PID documented by laparoscopy and/or endometrialbiopsy, 58 women (27% of the initial cohort) were interviewed by phone 2 to 9 years after an indexepisode of PID. Data regarding the initial history, physical examination, microbiology, laparoscopic,and serologic findings, and data concerning interval contraception, subsequent pregnancy, subsequentinfection, and chronic pelvic pain were compared among those with and without infertilityat follow up.Results:Nineteen (40%) of the 48 women not using contraception were involuntarily infertileafter the index episode of PID. Compared with those who had an interval pregnancy, infertilewomen were older (P= 0.02), more likely to have a history of infertility prior to the index episodeof 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 laparoscopyperformed during the index episode. Surprisingly, recovery ofChlamydia trachomatiswas negativelyrelated to infertility (P= 0.001), although a similar proportion of both groups had chlamydiaimmunoglobulin M antibody (40% vs. 31%). Chlamydia heat shock protein was weakly related toinfertility (P= 0.08). The isolation ofNeisseria gonorrhoeaewas not significantly different betweengroups (53% vs. 57%).Conclusions:The high rate of postinfection infertility found was probably related to a combinationof tubal damage before and during the index episode of PID. Prevention of recurrent PID and betterunderstanding of the pathophysiology of postinfection tubal damage (which may differ betweenchlamydia and gonorrhea) is needed to develop more effective strategies to reduce permanent tubaldamage. Infect. Dis. Obstet. Gynecol. 7:145–152, 1999.

[学科分类] 妇产科学