DELAYED CARE OF PELVIC INFLAMMATORY DISEASE AS A RISK FACTOR FOR IMPAIRED FERTILITY

OBJECTIVE: We evaluated the relationship between delayed care of sympt omatic pelvic inflammatory disease and impaired fertility. STUDY DESIG N: We used data from a cohort of women with clinically recognized pelv ic inflammatory disease. Case patients were women with either ectopic pregnancy or infertility (n = 76); controls were women with intrauteri ne 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. CONCL USIONS: Women with pelvic inflammatory disease who delay seeking care are at increased risk for infertility and ectopic pregnancy. Furthermo re, our data suggest that prompt evaluation and treatment of chlamydia l pelvic inflammatory disease can prevent these sequelae.