24,000 women become infertile every year as a result of an undiagnosed STD. That's a lot of sad surprises.
Some sexually transmitted infections are hard to miss. The weepy sores of a herpes outbreak, for instance, tend to demand one's attention. But often, STIs come in silence and can hang out in the body for months or years without any symptoms, quietly doing damage that may prove heartbreaking later.
Caught early, chlamydia is cured easily with antibiotics. Gonorrhea is a bit more of a chore to treat, but it too can be cured if discovered quickly. The problem, though, is that they're often not detected at all, because they don't always have noticeable symptoms. And this can mean that down the road, becoming pregnant might be nearly impossible.
Each year, according to the CDC, there are about 2.86 million cases of chlamydia and 820,000 cases of gonorrhea in the United States. Of those who don't seek treatment, up to 40 percent of women with chlamydia will develop pelvic inflammatory disease (PID) and 12 percent of those women will go on to experience infertility. In 2013, the CDC estimated that undiagnosed sexually transmitted diseases cause 24,000 women each year to become infertile. That's a lot of women getting a sad surprise.
Sana N. Khan, an obstetrician and gynecologist who works with the department of Reproductive Endocrinology and Infertility at Detroit Medical Center, says that sexually transmitted infections can affect female fertility by damaging reproductive organs in the female tract—the fallopian tubes in particular. "A sexually transmitted infection comes through the vagina and can go through the cervix into the uterus," Khan says. "Then it can go into the tubes from the uterus. The tubes are the most likely to harbor the infection." The uterus itself can also be damaged.
If you need a refresher, the fallopian tubes are what connect the ovaries and the uterus. A lot of crucial steps to conception rely on them. Eggs need to travel toward the uterus through the tubes after being released by the ovary. The tubes are also where egg and sperm encounter one another and, should an egg meet up with a sperm cell and become fertilized, the zygote continues its journey into the uterus in the tube. Fallopian tubes are critical, delicate, and vulnerable.
"There are fine cells within the tube," Khan says. "They have very specialized functions. Those infections damage the fine function." Infection can also cause the fallopian tube to balloon out and collect fluid, creating a toxic environment for an embryo. Once fallopian tubes have been compromised, Khan says, getting pregnant naturally is nearly impossible.
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For men, untreated STIs are less likely to imperil fertility, but they can still do it. Male reproductive tracts can be physically damaged by long-term infection. Khan also says the sperm cells can be damaged, leading to problems in morphology (the size and shape of sperm) and motility (how well they can swim).
Gonorrhea and chlamydia occur most often among people ages 15 to 24. "These are things that often a lot of people are exposed to in college or even younger," Khan says. The CDC says women are having children older—the mean age for first time mothers increased to over 26 in 2016. So by the time a woman is starting to consider getting pregnant, it's possible she's been carrying an infection for years.
Treating the underlying infection is important, but it doesn't reverse the fertility-destroying damage. "Unfortunately, when they come to us, when they get to that level, it's too late," Khan says. Patients don't typically seek out fertility care until they've been trying to conceive for a year, or six months if the woman is over 35. If an undiscovered STI has caused the problem, it's well-established after that long.
No medication or surgical protocol Khan has heard of can restore the tubes. There is one option for getting pregnant that takes the tubes out of the equation. "When you have these kinds of infections and you have damage to the tubes, in vitro fertilization is often still an option," Khan says. "IVF is very expensive and can be cost-prohibitive for some people. For some people who are blessed to have a lot of financial resources, that could work out for them."
IVF bypasses the fallopian tubes entirely. It involves treating a woman with a potent cocktail of hormones and other drugs to make her ovaries hyper-productive, with far more eggs maturing in her ovaries than during a usual cycle. Once they've sufficiently matured, the eggs are harvested by puncturing the vaginal walls with a needle that goes into the ovaries and removes the eggs. Those are then fertilized with sperm from the woman's partner or a donor, and the strongest of any resulting embryos are reintroduced into her uterus with a catheter through the cervix.
A single round of egg retrieval and transfer starts in the neighborhood of $10,000, and the companion medications can run between $3,000 and $5,000 and up—and that's for a relatively simple protocol for a healthy woman. Drug and surgical protocols vary from clinic to clinic, doctor to doctor, and even cycle to cycle. Often, insurance covers none of it.
Nailing down success rates for IVF is maddeningly imprecise. The Society for Assisted Reproductive Technology has a calculator that factors in age, prior pregnancies, and reasons for difficulty conceiving. Results vary wildly, but it's safe to say IVF is more likely to fail than succeed.
All this is to say that yes, it can be possible to conceive after sexually transmitted infections have damaged a woman's fallopian tubes. But they are costly and demanding protocols that are by no means guaranteed to work. It's not a simple matter of "just" doing IVF.
"Really, the best advice is safe sexual practices. Have a very low index of suspicion: Did [you] potentially get exposed?" Khan says. "Go in and get evaluated right away."
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