1 June 2018

How does chlamydia affect fertility?

By the Editorial Comitee IVI Blog


Chlamydia is an insidious disease, often called the silent killer due to its lack of outward symptoms. Infected persons can go for weeks, months, or even years without knowing that they have contracted the STI. They may continue to spread it, unaware that they even have it. This leads to an increasing rate of spread, especially in those aged under 25. It is possible for women, in particular, to mistake the symptoms of chlamydia, if they do present, for those of something less serious. Lower back pain, fever and nausea may all be explained away rather than taken seriously. Unfortunately, during this time chlamydia attacks the body, often having an irreversible effect on key functions such as vision and reproduction. For men the disease is symptomless in around half of cases, but their fertility can be hampered regardless. Once detected Chlamydia is easy enough to treat, with antibiotics. Those with diminished fertility due to chlamydia infection may be suitable for and benefit from fertility treatments including In Vitro Fertilisation (IVF).


The spread of chlamydia

This particular STI is much more common in young people under the age of 25. The spread is more rapid among young women in particular. This may have something to do with the advent of hormonal birth control, as those taking it may be more likely to have sex without a condom. This may leave them exposed to infection. Though the pill, implant, coil and other forms of hormonal birth control prevent pregnancy, they offer no protection against STIs. Gonorrhoea and syphilis are also on the rise, but chlamydia remains the most commonly reported STI in Europe. Gay men are also susceptible to the disease in their throats and rectums, though women who are exclusively lesbian have a rate of diagnosis of less than 1%. It is recommended that sexually active people under the age of 25 get tested for chlamydia, and other STIs, at least once a year. The test is non-invasive and not painful. Treatment for chlamydia is relatively straightforward: a course of antibiotics can usually clear the infection up.


Chlamydia and infertility

The effects of chlamydia on fertility are well established and apply to both men and women. In the case of the female reproductive organs the disease can cause tubal ligation, or scarring, on the fallopian tubes, preventing ovarian uptake or causing miscarriage, premature birth or still birth. Around one in five women with chlamydia develop pelvic inflammatory disease (PID). Though this can be treated with antibiotics, like chlamydia it may go unnoticed and undiagnosed for a period of time, allowing the disease to irreparably affect the ovaries, fallopian tubes and uterus. PID can cause ectopic pregnancies, where the fertilised egg implants into and develops inside a fallopian tube instead of the lining of the uterus. Ectopic pregnancies are extremely dangerous and life-threatening for women, as well as distressing.

The symptoms of chlamydia in women are different from those observed in the opposite sex. Around 75% of women do not develop symptoms, and those that do may mistake them for other issues. The symptoms of chlamydia in men are pain while urinating, discharge from the penis and pain in the testicles. Around 50% of men with chlamydia will develop symptoms within one to three weeks of contracting the disease, which makes it more noticeable for men than women. However, men who suffer from chlamydia may find that as a result their sperm has significantly decreased in quality and mobility, leading to a much harder time conceiving. In this instance, while antibiotics can clear up the infection, it may be advisable to approach a fertility specialist for assistance.


Fertility treatments after chlamydia

IVI are world leaders in treating difficult cases of infertility, and we apply our expertise and knowledge to even the most extreme situations. Each patient is treated as an individual and approached with the care and sensitivity that is expected in this field. Many will be delighted to hear that untreated chlamydia does not necessarily mean that it is impossible for a couple to conceive. With a little assistance from one of our clinics, many patients are able to see their dream of having a family come true.

IVF is a popular choice for those suffering from the after-effects of chlamydia. For women who may have scarring on their fallopian tubes, the process is ideal. The egg (oocyte) is collected from the ovary, fertilised and then implanted straight into the uterus. This makes it possible to circumvent any issues that the patient may have with blocked fallopian tubes or with tubal ligation. It also rules out any chance of ectopic pregnancy. Male patients may find that the speed and mobility of their sperm has been affected by chlamydia. Where this is the case it may be beneficial to take the sperm directly from the testes, rather than collecting it via ejaculate. This means that the best quality sperm can be taken straight from the source and used to fertilise the egg, which is then implanted into the uterus.

There is a chance that sperm may be negatively affected by chlamydia in other ways, however, and these include fragmentation. In this case, it may be advisable for the patient or patients to undergo preimplantation genetic screening (PGS), to ensure that the cycle is given the best possible chance of success. PGS flags up issues with genetic material and allows medical professionals to avoid implanting an embryo with a poor chance of thriving, or with the potential for genetic abnormalities. If sperm from the male patient is unsuitable for use following chlamydia, there is always the option of using a sperm donor. This may be a great choice in extreme cases where sperm has been irredeemably affected by a prolonged infection.


Can women with chlamydia give birth?

The ways in which this particular STI is transmitted are through vaginal, oral and anal sex, and also potentially when the mother is giving birth. Chlamydia may lead to a pre-term birth, and potential risks to the baby include conjunctivitis and other eye infections, as well as pneumonia. Symptoms will present in a few days to three months following birth, and it is vital that the baby is treated with antibiotics. However, the risk of passing chlamydia on to offspring during birth is almost completely eradicated if the mother-to-be receives treatment for the disease in the first trimester of her pregnancy. As long as expectant mothers who have previously been infected with chlamydia have been treated effectively and monitored, they do not need to worry about the infection persisting.

For patients who opt to undergo fertility treatment with IVI, there is no risk of contracting chlamydia through the process. Patients opting to use a donor egg or donor sperm need not worry that either of these genetic materials will be infected with chlamydia, as our donors undergo rigorous testing before being allowed to donate. Not only will patients be given a full battery of tests prior to treatment, they will also have medical advice on hand for any questions or concerns that they may have. Patients can have complete peace of mind in this respect.


Possibility of reinfection

Any woman who has previously been infected with chlamydia, or whose male partner has been infected, should be on the lookout for symptoms if there is any risk of reinfection. Risk factors in this respect may include having multiple sexual partners. It is recommended that pregnant women continue to use condoms if choosing to engage in sexual activity with a partner who has not been tested for STIs. At IVI, patients will be tested and treated for chlamydia prior to going ahead with fertility treatments, whether they are opting for IVF or for an alternative procedure. If there is any possibility that the patient could become infected or re-infected during her treatments or pregnancy, she must make her situation known to the clinic and our medical team will do everything in their power to prevent harm to the foetus.


No barrier to children

The reality is that while chlamydia can be damaging to both men and women, having irreversible effects, they can still be overcome. While the odds may be stacked against sufferers or former sufferers trying to conceive naturally, IVI has a long history of assisting patients with more complex needs. Conceiving and giving birth following diagnosis of and treatment for chlamydia is absolutely possible. There are a range of fertility treatment options, of which IVF may be the most suitable, either with patients’ own genetic material or with donated eggs or sperm.


Chlamydia can affect fertility, but with the range of options and expertise available at IVI clinics worldwide, a past infection need not dash any hope of starting a family.



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