National Infertility Awareness Week is April 22 – 28, 2019. It's a chance to talk openly about a disease that affects one in six couples. As a fertility doctor, many people tell me that they spent their 20s trying not to get pregnant. So understandably, it's frustrating that when they are ready, pregnancy doesn't come naturally to everyone.
Part of the stigma of infertility arises from misconceptions around what actually causes it. Women tend to blame themselves and internalize the failure, when the truth is that the majority of causes are out of their control. The two most common reasons for infertility are sperm problems (aka male factor) and scar tissue (aka pelvic factor).
Sexually transmitted infections (STIs) are one of the most common reasons why a woman might have scarring around the tubes and ovaries. Even if the infection happened many years ago, once formed, scar tissue does not go away and can affect fertility decades later. According to a February 2019 report by the World Health Organization, more than one million STIs are acquired every day worldwide.
Watch: What no one tells you about infertility. Blog continues below.
Canada is no exception to the rising rates of sexually transmitted infections. This may be due to individual choices, like opting for birth control pills over condoms, along with better testing and diagnosis. Knowing the facts about STIs can help you recognize the signs and get the right treatment quickly. The majority of STIs are curable and early intervention will usually prevent long-term consequences like infertility.
Chlamydia and gonorrhea are among the most common STIs in Canada and the worst for your future fertility. Chlamydia is a bacterial infection of the cervix and urinary tract. Women are more likely to be diagnosed with chlamydia than men. In some women, the infection can go undetected for months while others may experience a yellowish discharge or pain with urination. If caught early, chlamydia infections are easily treated with oral antibiotics.
Gonorrhea ("The Clap") targets the reproductive tract but can also infect the eyes, rectum and throat. Like chlamydia, the mild symptoms of gonorrhea may go unnoticed in women, or be mistaken for a bladder infection. Typically, a one-time dose of antibiotics is enough for a complete cure.
In severe cases, chlamydia and gonorrhea can evolve into pelvic inflammatory disease (PID) and form abscesses in the lower abdomen, tubes and ovaries. These situations are more serious and can require hospitalization or surgery.
To get pregnant naturally, the tube is essential. It is where the sperm meets the egg for fertilization.
Chlamydia and gonorrhea rates are highest in women aged 15 to 24 and in men aged 20 to 29 years old. Those at risk should get tested regularly. A urine sample can be used to check for chlamydia and gonorrhea. Women may also get swabbed for STIs at the same time as their annual PAP test. Chlamydia and gonorrhea are both considered reportable diseases, which means that laboratories must pass on the results to the provincial Centres for Disease Control for tracking.
If you are diagnosed with an STI then your last partner, along with all sexual contacts in the past 60 days, should be tested and treated.
Even if it occurred more than ten years ago, any infection with chlamydia or gonorrhea can lead to difficulty getting pregnant. The fallopian tubes, which connect the ovaries to the uterus, have a very delicate lining. Inflammation from an STI can leave the tubes blocked or incapable of proper transportation.
To get pregnant naturally, the tube is essential. It is where the sperm meets the egg for fertilization. The embryo actually grows for five days as it travels down the tube before reaching the uterus. If the tube is only partially blocked, a sperm may reach the egg but the embryo will get stuck in the damaged tube. An embryo that grows inside of a tube is called an ectopic pregnancy. Symptoms of an ectopic pregnancy usually start around five to eight weeks gestation with sharp pain. Left untreated, the pregnancy can grow large enough to rupture the tube leading to internal bleeding.
An X-ray dye test called a hysterosalpingogram (HSG) can check if the tubes are open. If one or both tubes are blocked, specialized procedures such as tubal cannulation or tubal surgery can attempt to fix the obstruction.
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In vitro fertilization (IVF) is the most effective treatment for tubal infertility. IVF bypasses the tubes by suctioning eggs directly from the ovaries and fertilizing them in the lab. The embryos grow for five days in an incubator before being transferred back into the uterus.
In summary, sexually transmitted infections, even if they occur in your 20s, can affect your fertility later in life. Chlamydia and gonorrhea are among the most common STIs. Fortunately, if caught early, they are also the most easily cured. The best ways to prevent STIs are to have a candid conversation with your partner about the risks, use condoms and see your doctor for regular testing.
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