Infertility and the Hidden Epidemic of Sexually Transmitted Infections

Reproductive health services contribute not only to reducing unintended pregnancies and the spread of disease, but can also assist couples who wish to conceive to overcome fertility problems. Roughly one in ten couples around the world have difficulty conceiving at some point in their lives. In sub-Saharan Africa the proportion may be one couple in three.

More than 50 percent of infertility cases worldwide result from largely preventable causes, such as sexually transmitted infections (STIs), unsafe abortion, and complications of childbirth. Sexually transmitted infections can lead to infertility in women by scarring the fallopian tubes and impeding their normal function. In men, infections can cause inflammation of the genital tract and affect sperm production and release. While infertility affects both men and women, some cultures firmly place the blame on women—and the social backlash is often powerful and punitive.

Worldwide, approximately 333 million new cases of curable sexually transmitted infections, including syphilis, gonorrhea, chlamydia, and trichomoniasis, occur annually. These infections respond well to antibiotics. Many, however, do not announce their presence with symptoms, so they go undetected and untreated, putting couples at risk of reproductive tract infections, infertility, and stillbirths. Sexually transmitted infections increase vulnerability to contracting HIV, which also may impair women’s fertility. Indeed, new evidence from sub-Saharan Africa shows that women infected with HIV may bear 20 percent fewer children than their uninfected peers.

Early age at first intercourse is strongly associated with infertility. The immature reproductive tracts of girls make them more susceptible than adult women to acquiring sexually transmitted infections. For example, in the United States, young people 15 to 19 years old have the highest rates of STIs. Multiple sexual partners and female genital mutilation can also increase risk. Unhygienic delivery practices and restrictive abortion policies that limit women’s access to safe abortion services contribute to infertility by increasing the likelihood of infection.

Treatment of infertility is extremely costly and interventions focused on prevention are the most cost-effective public health measures, especially in resource-scarce regions such as sub-Saharan Africa. Clinics that provide other reproductive health services can also offer services—whether information or the promotion and provision of barrier contraceptive methods (condoms) that protect against most STIs—that help prevent infertility without adding substantially to their costs. Prevention-oriented programs should also make a concerted effort to reach adolescents since they are less likely than adults to use health services.