How Do Pelvic Infections Cause Infertility?

The pelvis is very important in female reproduction because it houses most of the reproductive organs. For the same reason, pelvic inflammatory diseases (PID) are known to be a common cause of infertility among women. In most cases, an infection of the pelvis begins as a sexually transmitted disease (STD) caused by gonorrhea or chlamydia infections of the cervix. These infections are usually asymptomatic or in the worst cases cause cervical discharge. The bacteria responsible for these infections can rise from the cervix to the uterus and fallopian tubes, causing a painful infection and a buildup of pus in the tubes.

The rise of the infection can be stopped with the use of antibiotics in the early stages, but the normal body defenses with or without antibiotics will contain the infected bacteria and act by forming a walled abscess over it. The abscess will eventually resolve in one of two ways. The abscess cavity will either sterilize, the fluid will eventually clear and the abscess will disappear, which is better, or it will rupture and the infection will spread causing more abscesses, which is very bad for fertility.

To get a better picture of how pelvic diseases affect fertility, you should keep in mind that when a pathogenic bacteria such as gonorrhea or chlamydia reaches the uterus and uterine tubes via the cervix, it has not been stopped by the use of antibiotics or has been stopped by antibiotics. The body’s immune system peels off the inner surfaces of the tubes from the skin called the epithelial lining. A few white blood cells form a closed space around pathogenic bacteria in their attempt to control the infection. This space is so filled with proliferating bacteria and fluids that that area of ​​the tube fills with pus.

Even if treated at this stage, damage has occurred. The destroyed lining of the tube can cause the walls of the tube to stick together, causing the tube to become blocked later in both egg and sperm cells. In order for pregnancy to occur, the sperm cells and the egg must meet in the tubes for fertilization to occur, and the fertilization product must be transported from the tube to the uterine cavity in time for implantation. Thus, even if the tubes are not clogged by the agglutination of their walls due to stickiness caused by past infections, the destruction of the tube lining continues to affect fertility, since the ciliary wave action of the tubes serving to move the fertilized egg downwards still affects fertility. the uterus is lost just in time for implantation.

Worst of all, if the tube abscess opens or leaks from the end of the tube, the ovary at that end of the tube may attach to the tube and there may be another far wall of the abscess cavity, which is now larger and larger. devastating. This is called a tubo-ovarian abscess and causes complete loss of fertility on the side where it occurs as the tube, ovary, and all of its eggs are destroyed.

It is estimated that 5-10% of women with PID develop the most severe form, tubo-ovarian abscess. Women with this condition tend to be older (in their thirties and forties) and also suffer from severe pain and possibly nausea, vomiting and abdominal bloating.

Although tubo-ovarian abscess can occur due to some other factors besides untreated STDs, these include:

– Post pelvic surgery

– Uterine perforation during D&C or any vaginal procedure

– Intestinal perforation after ruptured appendicitis

– Bowel perforation after diverticulitis

– Pelvic malignancy

Pelvic inflammation disease that develops into abscess cavities is usually initially treated with a broad-spectrum antibiotic. An abscess is often viewed as a mixed infection because although the initial infection is usually from an STD bacteria, many different bacteria can enter the abscess from the intestinal tract due to passage through the swollen, inflamed intestinal walls surrounding the abscess area. . Usually at least two to three different antibiotics are needed at the time of diagnosis. If the infection does not usually resolve within 72 hours, some type of surgical drainage of the abscess is required. If all this fails, then as a last resort, exploratory surgery is performed, which removes all of the infected tissue.

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