What you should know about STDs and Your Fertility

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If you gain nothing else from from this article, please read the following five bullet points:

  1. Chlamydia and gonorrhea often have no symptoms.

  2. Long term infections of chlamydia and gonorrhea can lead to pelvic inflammatory disease (PID).

  3. Long term infection can lead to ectopic pregnancy.

  4. PID leads to infertility.

  5. Having chlamydia or gonorrhea and then becoming pregnant can lead to ectopic pregnancy.

The bottom line: If you have any history of STIs at all, talk to your doctor about what your options are. Don't freak out, and don't give up hope. There are often many different things you can do to help improve your odds of conception. The key is to communicate with your doctor and figure out what's going on with enough time to take care of business.

Maybe you're actively trying to conceive a child. Or maybe you are pretty sure you want kids down the line. Or maybe you just want to keep your options open. If any of those apply to you — whether you're a man or a woman, cisgender or transgender — here's what you have to know about how sexually transmitted infections (STIs) play a role in your future fertility, specifically how chlamydia and gonorrhea play a role in your fertility.

Understand that everything we're about to tell you is meant to inform you, not totally freak you out. We want you to be able to engage in sex safely and keep those baby dreams alive. STIs can sometimes make it harder to get pregnant naturally, but that doesn't necessarily mean you'll never have babies. Sit back and relax and read on about the basic facts about which STIs do what, how to keep yourself and your fertility safe, and what do if you’ve had any of these STIs and are or potentially will be trying to have a baby.

Chlamydia and Gonorrhea

Let’s start with chlamydia and gonorrhea. Both could potentially hurt your future fertility, regardless of your gender. For cisgender women and transgender men, gonorrhea and chlamydia can potentially cause scarring and damage to the fallopian tubes.This is why it's so important to get tested if you're at risk for STIs — and get treated ASAP if you happen to contract one. The sooner you can treat and cure chlamydia or gonorrhea, the less likely they are to cause damage to your reproductive organs.

Another reason to stay on top of your screening and treatment: In cases where these infections go unnoticed or untreated for long enough, they can migrate further into the pelvis and cause pelvic inflammatory disease (PID). "By the time PID happens, significant damage has happened to your tubes," Dr. Lubna Pal, reproductive science specialist, OB-GYN, and director of the Polycystic Ovary Syndrome Program at the Yale University School of Medicine describes. Additionally, if you have PID once, you're at a greater likelihood of developing it again.  Scarring or damage to the fallopian tubes can cause what is referred to as "tubal infertility." Scarred and damaged fallopian tubes can prevent sperm from reaching and fertilizing the egg. And if an egg does get fertilized, blocked tubes can also keep that fertilized egg from reaching the uterus. This can increase your odds of having an ectopic pregnancy — when the embryo implants in the fallopian tube wall, rather than in the uterus wall. Ectopic pregnancies are completely nonviable, and they're very dangerous — and can even be fatal.

For cisgender men and transgender women, gonorrhea and chlamydia can potentially damage your pipes as well, although it's very rare, and much less common than fallopian tube damage. "The male reproductive tract — the urethra and the ejaculatory duct — can be affected by STDs like gonorrhea and chlamydia; they can be scarred, which causes an obstruction," Dr. Thomas Molinaro, a reproductive endocrinologist at Reproductive Medicine Associates of New Jersey (RMANJ) in Eatontown said. "It's definitely less prevalent than gonorrhea or chlamydia affecting fallopian tubes in women, but it is still something that we see and that men should be aware of."If you have a penis and your urethra and ejaculatory duct are blocked, it can prevent you from actually releasing sperm. STI-related damage obstruction in men is rare, but not unheard of. "I've seen patients who have an inability to release the sperm; the outflow tract is scarred down from previous STIs," Molinaro says. "There are some surgeries that can be done, but oftentimes when you have an obstruction like that, it requires testicular biopsy to get sperm." Not so fun.

Chlamydia and gonorrhea often have absolutely no symptoms at all, so you might not even realize you're infected.This is why it's incredibly important to get tested and know your status — the longer you're infected with chlamydia or gonorrhea, the greater the likelihood that these infections can damage your tubes. It also means that you might inadvertently infect your partner, impacting THEIR future fertility as well.

You can lower your risk of contracting chlamydia and gonorrhea by practicing safe sex.What this means: Unless you're in a mutually monogamous relationship where you and your partner have both tested negative for all STIs, you should use a condom or barrier method every time you have sex, whether it's vaginal, anal, or oral. Condoms aren't 100% effective — they can break, for instance, and some infections, like HPV, can be transmitted from skin-to-skin contact that isn't always covered by a condom. But they can definitely help prevent the spread of chlamydia and gonorrhea, and they're absolutely better than going without.

Chlamydia and gonorrhea are TREATABLE diseases — and the sooner you detect them, the sooner you can get treated for them. Chlamydia and gonorrhea are both bacterial infections, which means that they can almost always be treated with antibiotics. If you or your partner are diagnosed with chlamydia or gonorrhea, make sure that you take doctor-prescribed antibiotics to treat the infection ASAP. The sooner you get treated, the less likely they are to cause damage to your reproductive organs. Your doctor will prescribe antibiotics to treat cases of PID, but as with chlamydia and gonorrhea, it's super important to address it quickly. The longer you go untreated, the more damage it can cause.

When you're taking antibiotics to treat an STI or PID, take the entire course of antibiotics. This is so important: DON'T STOP taking antibiotics just because you feel better. You can stop experiencing symptoms before the infection has been totally eradicated, which means that it can still cause problems for you.

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If you Want to have a Baby

Find out if you're currently infected with anything. If you are, get treatment ASAP. Talk to your doctor about any STIs you've ever had, even if you've never had chlamydia or gonorrhea.

Again: Exposure to one STI increases your risk for exposure to others — so even if you've never been officially diagnosed with chlamydia, you still might have contracted it at some point in the past. Because potential damage to your tubes increases your risk of ectopic pregnancy, your doctor might want to keep an eye on you during your efforts to get pregnant, as well as tell you what to watch out for.

Typically, fertility experts recommend that if you're under 35, you should try to conceive for a year before seeking fertility treatment. But if you have a history of STIs (particularly chlamydia or gonorrhea), your doctor might tell you to try for six months before coming in for testing. They might also suggest you get certain tests before you even start trying. These recommendations will differ depending on your personal circumstances, as well as other health, lifestyle, and family history factors, so again: Communicate with your doctor, and work together to come up with a plan that makes sense for you.

If you've ever had chlamydia, gonorrhea, or PID, your doctor might want to perform a test to check to see if your fallopian tubes are blocked.For instance, they can perform an ultrasound test or an X-ray test to check for blockages. That said, these tests don't give you the all-clear, and even if your test comes back saying your tubes aren't blocked, it doesn't mean pregnancy is going to be easy — "The X-ray can tell you if your tubes are open, but they can't tell you if your tubes are working well," Pal says. If you do have damage to your fallopian tubes, there are still things you can do to get pregnant.

When it comes to tubal damage, "in today's day and age, the safest and most effective strategy is IVF [in-vitro fertilization]," Pal says. IVF is when your doctor extracts eggs from your ovaries, fertilizes them with sperm in a lab, and then injects them back into your uterus — bypassing your fallopian tubes altogether.

IVF can be incredibly expensive, and it's possible that your insurance won't cover the costs. But that's why educating yourself about your options and your situation is important: "It's about planning," Pal says. "If a 22-year-old knows her tubes are blocked because she had PID, maybe she can plan and save, or find the best insurance." If you have blocked fallopian tubes, you should talk to your doctor about your options.

Ultimately, being informed about these issues at the outset can help you better plan for your future — emotionally, financially, and with your choices around timing. If you know that you might need a costly medical procedure down the line, for instance, you may start saving for it early. Or if you know that it might take you a bit longer than most people to get pregnant, you might want to plan to start trying a bit earlier. Things like that.

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