SEVERITY OF PELVIC INFLAMMATORY DISEASE AS A PREDICTOR OF THE PROBABILITY OF LIVE BIRTH

OBJECTIVE: Our aim was to study the association between severity of pe lvic inflammatory disease at laparoscopy and the probability of achiev ing a live birth, while accounting for subsequent episodes of pelvic i nflammatory disease. STUDY DESIGN: Beginning in 1960 a cohort of 1288 women in Lund, Sweden, who had clinical symptoms of acute pelvic infla mmatory disease and who desired pregnancy was followed Br up to 24 yea rs. All participants underwent laparoscopy and were categorized by deg ree of salpingitis: mild (n = 371), moderate (n = 580), or severe (n = 337) pelvic inflammatory disease. Cumulative live birth rates, obtain ed by life-table analysis, and proportional hazards ratios were compar ed among women by severity of pelvic inflammatory disease, while accou nting for subsequent episodes. RESULTS: The cumulative proportion of w omen achieving a live birth after 12 years was 90% for women with mild , 82% for women with moderate, and 57% for women with severe pelvic in flammatory disease. The occurrence of subsequent episodes in women wit h mild pelvic inflammatory disease did not diminish their long-term pr obability of live birth, whereas it significantly lowered the probabil ity of live birth in women with severe pelvic inflammatory disease. Wo men with severe disease and subsequent episodes were eight times more likely to fail to achieve live birth compared with women with a single pelvic inflammatory disease episode with mild disease (relative risk 8.1;95% confidence interval 3.0 to 22.2). CONCLUSIONS: Increasing seve rity of pelvic inflammatory disease correlates with a lower long-term probability of live birth. Subsequent episodes have a greater impact o n women with severe pelvic inflammatory disease at the index episode c ompared with those with milder disease.