Ask the Doctor: STDs and Fertility

We asked Dr. Meike Uhler the most common questions she is asked about STDs and how they affect fertility:

Have you seen an increase in STD-related infertility?

According to the CDC, the total combined cases of chlamydia, gonorrhea, and syphilis reported in 2015 reached the highest number ever. Compared to the 1980s, there has been a 79% increase in syphilis and a 30% increase in gonorrhea, both of which impact fertility if left untreated. Another common STD that affects fertility is chlamydia, but the fertility impact of STDs can be greatly lessened or eliminated with proper treatment and an early diagnosis.

How does chlamydia affect fertility?

Chlamydia is the most common STD, and therefore, poses the largest threat. If left untreated, chlamydia can spread to the uterus and fallopian tubes, resulting in pelvic inflammatory disease (PID), long-term pelvic pain, and infertility. As a result of inflammation of the fallopian tubes, PID causes permanent damage to the reproductive system by scarring and causing blockage in the tubes. Scarring in the fallopian tubes can prevent a fertilized egg from reaching the uterus, resulting in an ectopic pregnancy, which can prove fatal if unaddressed. Chlamydia can also cause premature birth and can be passed to a baby during delivery, causing eye infection or pneumonia.

How does gonorrhea affect fertility?

Gonorrhea is the second most common STD and has health effects similar to chlamydia. While they are two different diseases, chlamydia and gonorrhea are commonly diagnosed together. If untreated, gonorrhea can cause Pelvic Inflammatory Disease (PID), which can result in scar tissue blocking the fallopian tubes, ectopic pregnancy, infertility and pelvic pain. Gonorrhea can also be passed to a baby during delivery, resulting in serious health complications. Treatment prior to delivery is essential for the safety of a newborn.

How does syphilis affect fertility?

Congenital syphilis can result in miscarriage, premature birth, stillbirth and death shortly after birth. Syphilis can have devastating health effects for a mother including paralysis, blindness, organ damage and death. Syphilis progresses through three phases, starting with one or more painless sores on the genitals, rectum or mouth. The second phase involves rashes on the skin, which can occur all over the body but are commonly found on the palms of the hands and soles of the feet. If left untreated, a mother with syphilis can pass congenital syphilis to her baby with devastating effects. Untreated babies can have health problems such as cataracts, deafness, seizures, deformed bones and organ abnormalities.

How does HPV affect fertility?

While HPV is not known to directly cause infertility, it is found in 99% of cervical cancers. Through early detection with a pap smear during an annual women’s wellness visit, cervical cancer cells can be detected and removed without affecting reproductive potential. Should cervical cancer progress, removing larger areas of cervical tissue may be necessary, which can weaken the cervix and increase chances of miscarriage. Cell removal can also decrease cervical mucus production, which may decrease the ability of sperm to swim up the reproductive tract.

How does herpes affect fertility?

Herpes HHV-6A was found to have a possible connection to unexplained infertility according to a small study published in the journal PLOS One. Approximately 43 percent of the 30 women in the study with unexplained infertility were found to have infections in their uterine lining. This is not the traditional herpes virus that causes cold sores and genital herpes, which has not been found to affect fertility. Herpes can cause complications when trying to conceive should an outbreak occur, requiring intercourse to be postponed. Should a woman experience an outbreak when going into labor, the baby must be born via C-section to prevent passing the infection on.

If I’ve had an STD in the past does my doctor need to know?

Yes - it is important that your doctor knows your complete health history. This can work to your advantage as it is usually recommended to try for a year (if a woman is under 35) before visiting a fertility specialist, but if you have an STD in your medical history that length of time may be reduced.

How do you treat tubal infertility?

Tubal blockage accounts for roughly one-third of infertility diagnoses and is one of the leading causes of infertility. Tubal blockage can result from PID or an STD that caused scarring in the tubes. Blocked tubes can also result from other infertility-related diagnoses such as endometriosis and fibroids. Some patients are lucky enough to have their tubes cleared after a hysterosalpingogram (HSG). During an HSG, dye is injected into the tubes and viewed through an x-ray to assess the inside of the uterus and fallopian tubes. Surgery can also remove a tubal blockage, but extensive tubal scarring poses a high risk for ectopic pregnancy and cannot be surgically treated. The next option for blocked tubes is IVF during which the ovaries are stimulated, eggs are retrieved and fertilized with sperm in the laboratory, then a healthy embryo is transferred to the uterus.

How do STDs hurt male fertility?

While rare, some men can have difficulty ejaculating sperm due to scarring in the outflow tract. A surgical procedure to remove scar tissue may be an option, but if not, sperm must be removed from the testicles through a testicular biopsy. The sperm can then be used in an IVF cycle.

If I think I have an STD and want to become pregnant, what should I do?

If you are experiencing symptoms such as increased or abnormal vaginal discharge, pain or a burning sensation during urination, vaginal bleeding between periods or if you notice sores on your genitals, rectum or mouth, visit a doctor for an evaluation. It’s important to note that many STDs, including chlamydia, gonorrhea and HPV, don’t exhibit any symptoms. Early diagnosis and treatment is the best way to safeguard fertility and restore health, so make annual STD screening and doctor visits a healthy habit. Pregnant women should undergo testing for syphilis, HIV, chlamydia, hepatitis B, and if at risk, gonorrhea, during a first prenatal visit.

Dr. Uhler has been treating patients for over 30 years and is board certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility. She sees patients at the Hinsdale and Warrenville locations.