The first priority when it comes to treatment of pelvic inflammatory disease (PID) is to deal with the underlying infection, even if you don't have any symptoms besides infertility when you're first diagnosed. PID can worsen overtime. The sooner it's treated, the less damage you'll sustain to your reproductive organs.
PID can also lead to serious pregnancy complications, which is just one of many reasons why PID must be treated before you get pregnant. Only after the infection is resolved should treatment of the resulting infertility be addressed.
Treatment of the Infection
Usually, PID treatment requires antibiotics, taken for one to two weeks. A variety of microorganisms can be responsible for pelvic inflammatory disease, and sometimes more than one microorganism is involved. Because it's difficult to determine which bacteria may be at fault, you may be treated with two or more different antibiotics at once.
Your doctor may also change the antibiotic treatment based on laboratory results. The antibiotics are usually taken by mouth, but sometimes, they may require injections. You may also receive pain medication and be encouraged to rest until you heal.
In cases of acute PID, or when oral or injectable antibiotics don't eliminate the disease, intravenous antibiotics may be required. This usually means hospitalization.
Other reasons for hospitalization for pelvic inflammatory disease treatment include pregnancy, an abscess on the fallopian tube or ovary, being HIV-positive, serious complications of PID, or uncertainty whether PID is the cause for illness or another serious medical problem, like appendicitis.
Surgery may be required if an abscess on the fallopian tubes or ovaries does not resolve with antibiotic treatment, or if the abscess ruptures or threatens to rupture. This can usually be done via a laparoscopy or laparotomy. In very rare cases, an emergency hysterectomy may be performed.
Treatment of PID Related Pain
After PID has been treated, pelvic pain can remain for some women. Pain may be caused by adhesions and scar tissue, which are not treated by the antibiotics.
Surgery may be recommended to remove adhesions caused by PID, but unfortunately, this may not resolve your pelvic pain problems completely.
Other options for chronic pelvic pain treatment include over-the-counter pain relievers, antidepressants (even if you're not depressed), hormonal treatments, physical therapy, acupuncture, transcutaneous electrical nerve stimulation (TENS), counseling, and trigger point injections.
In rare cases, hysterectomy may be used to treat chronic pelvic pain that does not resolve with other treatments. Surprisingly, even this may not cure your pelvic pain. It should only be a treatment of last resort.
Hysterectomy leads to sterility, and you will not be able to get pregnant or carry a baby afterwards. If hysterectomy is necessary, you should speak to your doctor about egg freezing or embryo cryopreservation before surgery, which together with a gestational surrogate, may allow you to have a biological child at a future date.
Treatment of PID Infertility
As mentioned above, the antibiotics used to treat pelvic inflammatory disease cannot repair the damage already caused by the disease. They only can treat the infection and, when successful, prevent further damage of the reproductive organs.
The most common cause of PID-related infertility is blocked fallopian tubes. If just one tube is blocked, and the other is clear, depending on other fertility factors, you may be able to conceive on your own. If both tubes are blocked, your treatment options include surgical correction of the blockage or IVF treatment.
With PID, the blockage is typically at the distal end, which means it's blocked by the ovary. This kind of blockage is more difficult to treat surgically than blockage by the uterus, but in some cases, about 25% of the time, surgery may allow you to conceive naturally, assuming there are no other causes for infertility.
Another common cause of PID-related infertility is hydrosalpinx. This is when the fallopian tube dilates and fills with fluid. For unknown reasons, hydrosalpinx may prevent optimal IVF success. You may need to have the affected fallopian tube completely removed to increase your chances.
If you have in addition to tubal blockage a lot of thick adhesions between your tubes and ovaries, your potential for success after surgical repair is low. IVF may be a better option for you.
When deciding between surgical treatment or IVF treatment, you should be sure to take into account other fertility factors, including your age, your partner's fertility, and any other complicating issues. Sometimes, it's best to skip right to IVF treatment and not attempt surgical repair. Speak to your doctor about your options.
If you're experiencing chronic pelvic pain, it may be worthwhile to have surgery to remove any adhesions and possibly correct blockages, even if the chance for natural pregnancy isn't high. Just be aware the surgery may or may not completely resolve the pelvic pain.
Whether you conceive naturally, after surgical repair, or with IVF, your risk of ectopic pregnancy is higher after pelvic inflammatory disorder. It's important to be aware of the signs and symptoms of an ectopic pregnancy, and your doctor should monitor you closely after conception occurs.
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Hydrosalpinx: Fact Sheet. American Association of Reproductive Medicine. Accessed November 6, 2008. http://asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/hydrosa%281%29.pdf
Pelvic Inflammatory Disease (PID) - CDC Fact Sheet. Center for Disease Control and Prevention. Accessed online July 26, 2011. http://www.cdc.gov/std/pid/stdfact-pid.htm
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