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The pelvis is very important in female reproduction because
it houses most of the reproductive organs. Due to this same
fact, pelvic inflammatory diseases (PID) have been known to
be a frequent cause of infertility among women. In most cases,
the infection of the pelvis starts off as a sexually transmitted
disease (STD) caused by either gonorrhoea or chlamydia infections
of the cervix. These infections are usually without symptoms,
or in worst cases, cause some cervical discharge. The bacteria
responsible for these infections could, from the cervix, ascend
into the uterus and fallopian tubes causing a painful infection
and an accumulation of pus in the tubes.
The ascension of the infection can be stooped by the use
of antibiotics in the early stages, though, the normal body
defence, with or without antibiotics, will act by forming
a walled-abscess over, and to contain, the infectious bacteria.
The abscess will eventually resolve in either of two ways.
The abscess cavity would either become sterilized, the fluid
eventually cleared and the abscess then goes away, which is
better, or it ruptures and the infection then spreads further
to cause more abscesses, which is very bad for fertility.
To get a better picture of how pelvic diseases affect fertility,
you should note that, once a pathogenic bacteria such as gonorrhoea
or chlamydia gets access above the cervix to the uterus and
uterine tubes, if not stopped by the use of antibiotics or
arrested by the body's immune system, the inside surfaces
of the tubes become denuded of their skin called the epithelia
lining. Several white blood cells, in their attempt to contain
the infection, form a closed cavity around the pathogenic
bacteria. This space becomes so filled with the multiplying
bacteria and fluids that that area of the tube become filled
with pus.
Even if treated at this stage, the damage has been done.
The destroyed lining of the tube may cause gluing together
of the walls of the tube, causing blockage of the tube later,
to both egg and sperm cells. For pregnancy to occur, the sperm
cells and the ovum must meet in the tubes for fertilization
to occur and the product of fertilization must be transported
from the tube to the uterine cavity on time for implantation.
So, even if the tubes don't get blocked by agglutination of
their walls due to stickiness caused by past infections, the
destruction of the tubal lining still affect fertility because
the ciliary wave motion of the tubes that serve to move the
fertilized ovum down to the uterus right on time for implantation,
is lost.
What could be worst is that, if the tubal abscess opens
or leaks from the end of the tube, the ovary at that end of
the tube may stick to the tube and become the far wall of
another abscess cavity, which is now bigger and more destructive.
This is called a tubo-ovarian abscess and it causes a complete
obliteration of fertility on the side it occurs, since the
tube, ovary and all 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 they
also suffer severe pain and probably nausea, vomiting and
abdominal distension.
Although, apart from untreated sexually transmitted diseases,
tubo-ovarian abscess can also arise due to some other factors
and these include:
- Post pelvic surgery - Uterine perforation at the time
of D&C or any vaginal procedure - Bowel perforation following
ruptured appendicitis - Bowel perforation following diverticulitis
- Pelvic malignancy
Pelvic inflammation disease that has degenerated into abscess
cavities is usually treated initially with a broad spectrum
antibiotic. The abscess is usually seen as a mixed infection,
because, though, the initial infection is often from a STD
bacteria, multiple different bacteria from the bowel tract
may become involved in the abscess due to transmigration across
swollen, inflamed bowel walls surrounding the abscess area.
Usually, at least two to three different antibiotics are required
immediately diagnosis is made. If the infection doesn't improve,
usually within 72hours, then some sort of surgical drainage
of the abscess is required. If all these fail, then as a last
resort, exploratory surgery removing all of the infected tissue
is carried out.
About the Author
Michael Russell
Your Independent guide to Infertility
Fertility
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