Getting Pregnant With PID: What You Need to Know
Published August 23, 2023.
Pelvic Inflammatory Disease (PID) is the inflammation of the pelvic area and lower tummy, specifically by the upper reproductive organs. It generally entails pain from internal tissue swelling, fevers, and sometimes unusual discharge and vomiting in extreme cases. The infection isn't visible but like other inflammatory responses there is increased redness and heat internally.
PID occurs when pathogens are admitted via the lower genital tract causing irritation and infection in the upper genital tract consisting of the uterus, fallopian tubes, and ovaries. This upper tract is imperative when trying to fall pregnant and keep a pregnancy to term. Studies estimate that it's most common between ages 15 to 25 and often occurs in sexually active individuals. So, if trying to conceive, managing PID and understanding your fertility is crucial.
To better grasp the connection between PID and fertility, we spoke to infertility researcher, healthcare professional, and author of Pregnancy After Infertility: A Guide to What’s Next & What’s Different, Natasha Hogan, to learn from her insight and make navigating PID and pregnancy easier to follow.
Understanding PID
Typically, PID may cause generalized discomfort, bloating, bleeding between periods or after sex, heavy periods or painful periods, or unusual discharge. Sometimes discharge can even be a different color or have a distinct smell. PID can also sometimes feel like a really full bladder.
PID Causes
There can be more than one pathogen that can lead to PID. Previously, it was associated with two major diseases, gonorrhea and chlamydia. But now, in addition, anything that can use or uses pressure that moves fluids (that could contain pathogens or bacteria) into the pelvic area can be linked to causing PID. This also associates PID with sexually transmitted infections or diseases.
Some other causes include:
- Infections after contraceptive IUDs are placed in the uterus
- Infections after gynecological procedures, such as D&C for an abortion or miscarriage
- Gastrointestinal and respiratory infections, such as streptococcus, E. coli, and certain influenza types
- Pathogens carried through water streams for bidets
- Higher susceptibility if you have other health conditions or complications, especially if your immune system is compromised
Some people may simply experience fatigue or not even know they have PID as no other clinical symptoms are presenting, so testing is important. Diagnostics include swab cultures, biopsies, pelvic exams, and laparoscopic procedures. Negative results from swabs or ultrasounds don't exclude a diagnosis as other factors can point to PID.
Another tool for potentially detecting PID is a tubal examination. Many women who have not fallen pregnant may undergo a tubal flush test. This test involves injecting a fluorescent dye and using ultrasound to visualize the flow of the dye through the fallopian tubes. It helps determine if there are blockages that could be preventing pregnancy.
How long does it take to develop PID?
Because PID's an infection, it can develop and build significantly within 5 days. But testing and treatment as early and as often as needed are crucial to avoiding any long-term effects. However, timelines can differ since some cases develop in a couple of days or weeks and others take up to a year.
Effect on the Reproductive System
Inflammation in any part of the body creates stress and pressure on the nearby tissues, and therefore the rest of the organs, nerves, and anything in the general area of the infection. This can result in increased pressure on all cells, leading to pushing and pulling, which creates scar tissue, adhesions, and obstructions, especially in the fallopian tubes.
The fallopian tubes are quite intricate, fine, and detailed, so they can be easily obstructed. This obstruction can create issues for anything trying to get through, such as the egg being released. You may also lose a lot of the delicate tissue, like the little hairs (cilia) along the fallopian tubes that help push the egg further into the uterus. Once the cilia are lost, they don't necessarily regrow.
Effect on Fertility and Pregnancy With PID
Many PID symptoms have an impact on fertility and the likelihood of pregnancy. So, can you get pregnant with PID? Simply put, yes. However, there may be complications. For instance, women with PID may experience ectopic pregnancies (fertilized egg implants outside the uterus, often in a fallopian tube) due to obstructing scar tissue.
Does PID cause infertility, and if so, how long does it take?
The uterus has a remarkable regenerative capacity monthly to differing degrees, but the delicate tissues along the fallopian tubes don't recover in the same way. In fact, tubal factors account for 25-35% of female infertility, with PID being a major causative factor. The time it takes for PID effects to lead to infertility can vary. "Having PID, especially more than once, significantly increases the risk of infertility, sometimes threefold," explains Hogan.
Can PID cause miscarriage?
PID is known to cause damage to the fallopian tubes and other reproductive organs, leading to infertility or reduced fertility and potential complications with childbearing in general. Because the chance of an ectopic pregnancy is six times more likely with PID, the likelihood of a miscarriage is much higher. So, if pregnant with PID, it can be very dangerous to your life and requires urgent monitoring.
PID and Fertility Treatments
Missed Diagnoses Concerns
Any in-vitro fertilization (IVF) clinic will likely accept you for treatment if you have PID. Although the risks may be higher, and it may take longer to conceive, most people don't often hear about a diagnosis of PID if it has been asymptomatic. Instead, clinicians may find another reason, like tubal issues or the presence of an abscess.
Hogan expresses the issue with this:
"There's a need to have more focus on PID classification. Doctors may say, "You have this in your uterus, and we need to clear it up," followed by a course of antibiotics. They usually assume that the antibiotics will resolve the problem. This is great if the pathogen is eradicated, but not if there are existing abscesses and growths, or if the body's immune system has already become accustomed to an inflammatory situation. It can set off a process that resembles an autoimmune disease."
Fertility Treatment Options
Some possible treatment options, although not necessarily designed for PID exclusively, can help. But ultimately, all treatment plans should be made under strict advisement and monitoring of your doctor and fertility specialist.
- Observation of certain cells: Cells, such as CIN2, and growths like tumors or abscesses should be checked for STDs, HPV, and more, which can affect fertility. These observations also help monitor intrauterine cancers. Ensure you have all your regular checkups and request these for yourself for your future fertility precautions if needed.
- IVF: IVF is a medical procedure where an egg and sperm are combined outside the body in a laboratory. This process takes out the issues related to fallopian tube damage or other PID-related problems, and the fertilized egg can be implanted directly into the uterus.
- Fertility medications: These can stimulate ovulation, potentially improving the chances of conception.
- Intrauterine insemination (IUI): This assisted reproductive technique involves sperm being placed directly into the uterus, making it easier timing-wise for the egg to release hopefully without traveling up through the fallopian tube.
- Surgical procedures: If surgery is required, it's crucial to research your surgeon, looking at their recommendations, past cases, and experience level. Because of possible complications and irreversible damage to the reproductive system, such as non-pliable uterine lining due to scar tissue or excessive thinning of the lining, surgeries to remove abscesses or adhesions should be approached with extreme caution and not as a first resort.
But for women who may have more extensive fertility-related issues due to PID that prevent them from carrying a baby, there are other options for motherhood, such as:
- Surrogacy: This offers the possibility to have a biological child. A surrogate carries the baby on behalf of the intended parents, and IVF may be used to facilitate the pregnancy.
- Adoption or fostering: For those who find that biological parenthood is not an option, adoption and fostering present opportunities to build a family.
How Soon Can You Get Pregnant After Treating PID?
Some IVF clinics may suggest that it's possible to conceive within a couple of months after treatment. However, the timing can vary significantly and depends on multiple factors, such as the severity of the infection, the symptoms presented initially, and the response to treatment.
Before attempting to conceive, it's advisable to look for signs of recovery and stability, such as:
- Reduced pain
- Fewer interruptions or irregularities with menstrual cycles (Unexpected menstrual bleeding might indicate the condition is not resolved)
- Return to normality in terms of sexual function (Persistent pain during intercourse could be a sign that the condition is not fully cleared)
Given the complexity of the situation and the potential risks, a cautious approach is recommended. A waiting period of at least 3-6 months post-treatment may provide a safer window to attempt conception. "Close monitoring and possibly more extended treatment or follow-up care may be required if symptoms don't clear up, so consultation with healthcare providers and adherence to their guidance is essential," says Hogan.
» Curious about other conditions that also impact fertility? Check out the difference between endometriosis and PCOS
Safety Measures to Lessen PID Development
- Sex education: This is especially important before women become sexually active. Examples include discussions about avoiding multiple partners, wearing condoms, and understanding the potential risks and benefits of different contraceptive methods, such as IUDs.
- IUD awareness: While IUDs may have been promoted more casually in the past, now it's recognized that they can lead to complications like PID. Due to heightened awareness and education, women are now better informed.
- Lessen smoking: This is particularly true if other risk factors are already in play, such as having multiple sexual partners or underlying health conditions, since the risk of infertility increases and will only worsen if PID also develops.
"When individuals know that they are clear of PID and understand the importance of precautionary measures, they become more resilient in adhering to safety practices. This includes being mindful of their future plans, such as having children and avoiding behaviors that might increase the risk of infection," explains Hogan.
» Discover how charting your cycle can help identify pregnancy concerns early
Understand Your Body to Help With Pregnancy
Further education and research on PID, including on individuals who aren't necessarily sexually active, is needed. Luckily, comparisons with swabs and pathology might help in understanding and preventing PID for now. And consultation with experienced medical professionals is key to making the best decisions for your reproductive health. To start small but impactfully, you can utilize tools like Tempdrop's wearable fertility tracker to pinpoint your basal body temperature (BBT), track cervical mucus, and identify your optimal fertility window.
