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  • Title: Infertility: a global perspective. The role of pelvic infection.
    Author: Sciarra JJ.
    Journal: ORGYN; 1994; (3):12-5. PubMed ID: 12345542.
    Abstract:
    The results of an examination of 5800 couples in 33 World Health Organization centers in 25 countries have provided the most comprehensive information on infertility in both developed and developing countries. Prior infection and bilateral tubal blockages were frequently traced as the cause of infertility. In the African sample; up to 64% of female patients had prior infection as the cause of infertility. A gynecological history of sexually transmitted disease, pelvic inflammatory disease (PID) and infection-related pregnancy complications of normal childbirth and abortion were directly related to infertility. 49% of the African couples and 11-15% of other patients in other parts of the world had infectious tubal disease. Westrom's study found that after PID 6-60% of patients became infertile. The factors affecting the infertility were the number and severity of infections, and the age when initial infection occurred. Between 1960 and 1980, in Sweden and the US, infertility doubled. Cates in the US has estimated that after 3 PID infections more than 50% of patients will be infertile. Ectopic pregnancy is another outcome of pelvic infection and sexually transmitted disease. Common PID infections are caused by Chlamydia trachomatis and Neisseria gonorrhea. These infections can cause tubal obstruction or pelvic adhesions and destructive tubal damage. After an ectopic pregnancy, 50% of patients are infertile and 10% have subsequent ectopic pregnancies. Some infertility may be treated. Microsurgery can be performed for tubal disease. Hysteroscopy can be used to treat intrauterine adhesions (Asherman's syndrome). Success has been better with hysteroscopy. Tubal microsurgery had led to conceptions in only 30-30% of patients, and a very high percentage of tubal pregnancies. The most successful results have come from tubal reanastomosis for reversal of tubal sterilization. The most promising results have come from "in vitro" fertilization and other methods of assisted reproduction. However, there must be a more simplified technology, improved results, and reduced costs before large numbers worldwide can benefit. The best approach is prevention and early detection of infection, and risk assessment. Culturally sensitive education programs will generally alert the population to precursor conditions of infertility.
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