Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility.

OBJECTIVE

We evaluated the relationship between delayed care of symptomatic pelvic inflammatory disease and impaired fertility.

STUDY DESIGN

We used data from a cohort of women with clinically recognized pelvic inflammatory disease. Case patients were women with either ectopic pregnancy or infertility (n = 76); controls were women with intrauterine pregnancies (n = 367).

RESULTS

Women who delayed seeking care for pelvic inflammatory disease were three times more likely to experience infertility or ectopic pregnancy than women who sought care promptly after adjustment for age, organism, year of diagnosis, and history of recent gynecologic events (95% confidence interval = 1.27, 6.11). This association was strongest for women with chlamydia; 17.8% (18/101) of those who delayed seeking care had impaired fertility, whereas 0.0% (0/13) of those who sought care promptly suffered known sequelae.

CONCLUSIONS

Women with pelvic inflammatory disease who delay seeking care are at increased risk for infertility and ectopic pregnancy. Furthermore, our data suggest that prompt evaluation and treatment of chlamydial pelvic inflammatory disease can prevent these sequelae.