DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20170464

Role of IgG Chlamydia antibody in tubal factor infertility

Sheila Balakrishnan, Anitha Malathi, Geetha Raveendran, Dolly Johnrose, Sreekumari Radha

Abstract


Background: Chlamydial infection is considered to be one of the important causes of tubal factor infertility. This study will help to explore the relationship between positive Chlamydial infection and tubal damage in infertile women assessed by diagnostic laparoscopy. The results will help to determine whether a policy of routine screening for Chlamydia antibody is justifiable in infertile women to suspect tubal factor so that they can be taken up for laparoscopy earlier.

Methods: A prospective study was performed on 158 consecutive patients who underwent laparoscopy as part of infertility evaluation. About 5 mL of venous blood was drawn preoperatively to detect Chlamydia IgG antibody in all the patients by ELISA. The laparoscopic findings were documented and the relationship to Chlamydial antibody evaluated.

Results: Of the 158 patients who underwent laparoscopy, 95 patients had evidence of tubal disease as evidenced by unilateral or bilateral tubal block, peritubal adhesions, hydrosalpinx, beading of the tube and unhealthy shaggy appearance. Of the 95 patients with documented tubal disease at laparoscopy, 14 (14.7%) had antibodies to Chlamydia. Of the 63 patients with normal tubes, 12 (19%) had Chlamydial positivity. The difference is not statistically significant. However of the 26 patients who were positive for Chlamydia antibodies 14 patients (53.8%) had abnormal tubes. Out of the 158 patients who underwent laparoscopy 26 patients were positive for Chlamydia. Hence the prevalence in our study is 16.4% (26/158). The sensitivity is 14.7% and the specificity is 81%.

Conclusions: This study showed no difference in Chlamydial positivity between infertile women with abnormal tubes and those with normal looking tubes in our population. The absence of Chlamydial antibodies cannot be taken as a marker for normal tubes. Hence screening for chlamydial antibody can neither be used as a screening test for tubal factor infertility nor to decide on the need for laparoscopy in the present population.

Keywords


Chlamydia trachomatis, Chlamydia antibody test, Infertility, Laparoscopy

Full Text:

PDF

References


Lalos O. Risk factors for tubal infertility among infertile and fertile women. Eur J Obstet Gynecol Reprod Biol. 1988;29:129.

Rosenfeld DL, Seidman SM, Bronson RA, Scholl GM. Unsuspected chronic pelvic inflammatory disease in the infertile female. Fertil Steril. 1983;39:44.

Ljubin-Sternak S, Meštrović T. Chlamydia trachomatis and Genital Mycoplasmas: Pathogens with an Impact on Human Reproductive Health. J Pathog. 2014;2014:183167.

Sharma H, Tal R, Clark NA, Segars JH. Microbiota and Pelvic Inflammatory Disease. Semin Reprod Med. 2014;32(1):43-9.

Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis. 2015;61(3):418-26.

Singh S, Bhandari S, Agarwal P, Chittawar P, Thakur R. Chlamydia antibody testing helps in identifying females with possible tubal factor infertility. Int J Reprod Biomed (Yazd). 2016;14(3):187-92.

Walsh MS, Hope E, Isaia L, Righarts A, Niupulusu T, Temese SV, et al. Prevalence of Chlamydia trachomatis infection in Samoan women aged 18 to 29 and assessment of possible risk factors: a community- community-based study. Trans R Soc Trop Med Hyg. 2015;109:245-51.

Land JA, Gijsen AP, Kessels AGH, Slobbe MEP, Bruggeman CA. Performance of five serological chlamydia antibody tests in subfertile women. Hum Reprod. 2003;18:2621-7.

WHO Task Force on the Prevention and Management of Infertility. Tubal infertility: serologic relationship to past chlamydial and gonococcal infection. Sex Transm Dis. 1995;22:71-7.

Shrikhande SN, Joshi SG, Zodpey SP, Saoji AM. Chlamydia trachomatis in pelvic inflammatory disease. Indian J Pathol Microbiol. 1995;38:181-4.

Neuer A, Spandorfer SD, Giraldo P, Dieterle S, Rosenwaks Z, Witkin SS. The role of heat shock proteins in reproduction. Hum Reprod Update. 2000;6:149-59.

Witkin SS. Immunity to heat shock proteins and pregnancy outcome. Infect Dis Obstet Gynecol. 1999;7:35–38.

Witkin SS. Immunological aspects of genital clamydia infections. Best Pract Res Clin Obstet Gynaecol. 2002;16:865-74.

Witkin SS, Sultan KM, Neal GS, Jeremias J, Grifo JA, Rosenwaks Z. Unsuspected Chlamydia trachomatis infection and in vivo fertilization outcome. Am J Obstet Gynecol 1994;171:1208-14.