Infertility and Sexually Transmitted Disease: A public health challenge
This review assesses the extent and causes of infertility throughout the world, particularly that caused by sexually transmitted diseases (STDs); discusses infertility therapy and prevention; and outlines the potential role of family planning programs in remedying the problem. For both sexes, infection, often caused by STDs, is the most common preventable cause of infertility. Treatment of either primary infertility (inability to have any children at all) or secondary infertility (inability to have additional children) is difficult, costly, and uncertain. Public health programs that focus on prevention are more practical and cost effective than programs attempting to treat infertility. Such programs could stress improved diagnosis and control of STDs, public education about them, expanded family planning programs emphasizing barrier methods and the pill, and improved delivery and maternal health care through training programs for traditional midwives. Infertility appears to be most widespread in tropical Africa, where over 30% of couples in some communities are childless; in some Asian countries, and in the Caribbean region. In most developing countries 2-3% of married women remain childless. The major causes of female infertility are infection and damage to the fallopian tubes, hormonal and ovulation disorders, and endometriosis. Infertility caused by after effects of genital infections is most common in developing countries and most difficult to treat. Childbirth and abortion can also be major sources of infection. STDs that cause female infertility, especially gonorrhea, chlamydial infection, and perhaps mycoplasmas, also affect males.