DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20190261

Usefulness of Chlamydia serology in prediction of tubal factor infertility among infertile patients at Federal Medical Centre, Bida, North Central Nigeria

Lucky Amadi, Uchenna Onwudiegwu, Adebanjo B. Adeyemi, Chiemezie N. D. Nwachukwu, Afolabi B. Abiodun

Abstract


Background: Infertility is a major public health problem in developing countries where pelvic inflammatory disease due mainly to Chlamydia trachomatis and Neisseria gonorrhea infection have been implicated. The role of Chlamydia serology in predicting tubal factor infertility (TFI) has been demonstrated by many researchers elsewhere. However, there are limited data in our environment. This prospective cross-sectional study aims to determine the usefulness of Chlamydia Serology as a screening tool for TFI at Federal Medical Centre, Bida, North Central Nigeria.

Methods: 125 women with infertility who met the inclusion criteria were enrolled into the study. Relevant information on their socio-demographic characteristics, gynaecological symptoms and risks factors for infertility were obtained. Participants had Hysterosalpingography (HSG) as part of their fertility work-up while 5ml of venous blood was withdrawn to check for Immunoglobulin G antibody to Chlamydia trachomatis using rapid test kits. The HSG findings were correlated with the result of Chlamydia serology. Data was analyzed using the computer software, Statistical Package for Social Science (SPSS) version 20. The level of significance (p value) was set at 0.05.

Results: A total of 120 infertile women completed the study, 5 had incomplete investigations and were excluded from the analysis. The prevalence of TFI was 47.5%, while that of positive chlamydia serology was 36.5%. The prevalence of chlamydial seropositivity was 59.6% for patients with TFI but 15.9% for non-TFI. There was a significant association between positive chlamydia serology and TFI p< 0.05. The study revealed moderate sensitivity 59.6%, and negative predictive value 69.7% but high specificity 84.1% and positive predictive value of 77.2%. In this study the odds for diagnosing tubal infertility was 7.8.

Conclusions: Chlamydia serology is useful in predicting TFI and should be incorporated in the routine work up for infertility.


Keywords


Bida, Chlamydia serology, Tubal Infertility

Full Text:

PDF

References


Fard SA, Ebrahimi FS, Montazeri F, Mashrabi O. Diagnostic features and therapeutic consequences of hysteroscopy in women with abnormal uterine bleeding and abortion. Am J App Sci. 2012;9(1):13-7.

Abma JC, ed. Fertility, family planning, and women's health: new data from the 1995 National Survey of Family Growth. National Ctr for Health Statistics; 1997.

Abolfotouh MA, Alabdrabalnabi AA, Albacker RB, Al-Jughaiman UA, Hassan SN. Knowledge, attitude, and practices of infertility among Saudi couples. Int J Gen Med. 2013;6:563-73.

Adams A, Sharpe A. Infectious diseases. In: Kuma FNV, Abbas AK, eds. Robbins and Cotran pathological basis of disease. 7th ed. Philadelphia: Elsevier Sanders. 2005:343-414.

Akande VA, Hunt LP, Cahill DJ, Caul EO, Ford WC, Jenkins JM. Tubal damage in infertile women: prediction using chlamydia serology. Hum Reprod. 2003;18(9):1841-7.

Alfarraj DA, Somily AM, Alssum RM, Abotalib ZM, El-Sayed AA, Al-Mandeel HH. The prevalence of Chlamydia trachomatis infection among Saudi women attending the infertility clinic in Central Saudi Arabia. Saudi Med J. 2015;36(1):61.

Araoye M. Epidemiology of infertility: Social problems of the infertile couples. West Afr J Med. 2003;22(2):190-6.

Audu BM, Massa AA, Bukar M, El-Nafaty AU, Sa'ad ST. Prevalence of utero-tubal infertility. J Obstet Gynaecol. 2009;29(4):326-8.

Chernesky, M. The laboratory diagnosis of Chlamydia trachomatis infections. Can J Infect Dis. 2003;16(1):39-44.

Coppus SF, Opmeer BC, Logan S, Van der Veen F, Bhattacharya S, Mol BW. The predictive value of medical history taking and Chlamydia IgG ELISA antibody testing (CAT) in the selection of subfertile women for diagnostic laparoscopy: a clinical prediction model approach. Hum Reprod. 2007;22(5):1353-8.

Dattijo LM, Andreadis N, Aminu BM, Umar NI, Black KI. The prevalence and clinical pattern of infertility in Bauchi, northern Nigeria. Trop J Obstet Gynaecol. 2016;33(1):76-85.

Dabekausen YA, Evers JL, Land JA, Stals FS. Chlamydia trachomatis antibody testing is more accurate than hysterosalpingography in predicting tubal factor infertility. Fertil Steril. 1994;61(5):833-7.

Etuk SJ. Reproductive Health: Global Infertility Trend. Niger J Physiol Sci. 2009;24(2):85-90.

Gerias A, Rushman H. Infertility in Africa. Popul Sci. 1992;12:25-46.

Ikechebelu JI, Adinma JI, Orie EF, Ikegwuonu SO. High prevalence of Male infertility in South eastern Nigeria. J Obstet Gynaecol. 2003;23(6):657-9.

Jain M. Correlation between the serum antichlamydial antibodies and tubal factor infertility. J Obes Gynec Lnd. 1993;43(3):380-4.

Jeremiah I, Okike O, Akani C. The prevalence of Serum Immunoglobulin G Antibody to Chlamydia trachomatis in Subfertile Women Presenting at the University of Port Harcourt Teaching Hospital. Int J Biomed Sci. 2011;7(2):120-4.

Kish L. Survey Sampling. New York. 1965.

Koledade AK, Adesiyun AG. Investigation Correlates of Chlamydia antibody testing and Hysterosalpingography among women with tubal infertility. Open J Obstet Gynecol. 2014;4(16):1077.

Lardenoije C, Land J. Chlamydia antibody testing for tubal factor infertility. Ned Tijdschr Geneeskd. 2007;151(36):1981-5.

Machado AC, Guimarães EM, Sakurai E, Fioravante FC, Amaral WN, Alves MF. High Titers of Chlamydia trachomatis Antibodies in Brazilian Women with tubal occlusion or Previous Ectopic pregnancy. Infect Dis Obstet Gynecol 2007;2007.

Mardh P. Tubal factor infertility with special regards to chlamydial salpingitis. Curr Opin Infect Dis. 2004;17:49-52.

Mol BW, Dijkman B, Wertheim P, Lijmer J, van der Veen F, Bossuyt PM. The accuracy of chlamydial antibodies in the diagnosis of tubal pathology: a meta-analysis. Fertil Steril. 1997;67(6):1031-7.

Morhason-Bello IO, Ojengbede OA, Oladokun A, Adedokun BO, Ajayi A, Adeyanju AA, et al. The prevalence and outcome of asymptomatic chlamydia infection screening among infertile women attending gynaecological clinic in Ibadan, South Western Nigeria. Ann Med Health Sci Res. 2014;4(2):253-7.

Odusolu P, Edet E, Emechebe C, Agan T, Okpe A. Prevalence of Chlamydia trachomatis immunoglobulin G antibody in infertile women in Calabar. Afr J Med Health Sci. 2016;15(2):74-9.

Olusanya O. The importance of social in voluntary fertility control in a developing country. West Afr J Med. 1985;4:205-12.

Omo‐Aghoja LO, Okonofua FE, Onemu SO, Larsen U, Bergstrom S. Association of Chlamydia trachomatis serology with tubal infertility in Nigerian women. J Obstet Gynaecol Res. 2007;33(5):688-95.

Sharma S, Mittal S, Aggarwal P. Management of infertility in low resources countries. BJOG. 2009;116:77-83.

Siemer J, Theile O, Larbi Y, Fasching PA, Danso KA, Kreienberg R, et al. Chlamydia trachomatis infection as a risk factor for infertility among women in Ghana, West Africa. Am J Trop Med Hyg. 2008;78(2):323-7.

Siladitya Bhattacharya. Infertility. In: Keith Edmonds, ed. Dewhurt’s Textbook of Obstetrics and Gynaecology. 7th ed. Blackwell: Oxford University Press; 2007:440-460.

Gold immunofiltration rapid test for Chlamydia trachomatis(IgG/IgM). Available at: www.spanbio.com.E-mailinfo@spanbio.com.

Stary A. Chlamydia Screening which sample for which technique?. Genitourin Med. 1997;73(2):99-102.

Surana A, Rastogi V, Nirwan PS. Association of the Serum Anti-chlamydial Antibodies with Tubal Infertility. J Clin Diagn Res. 2012;6(10):1692-4.

Thomas K, Coughlin L, Mannion PT, Haddad NG. The value of chlamydia trachomatis antibody testing as part of the routine infertility investigation. Hum Reprod. 2000;15(5):1079-82.

Torrone E, Papp J, Weinstock H. Centers for Disease Control and Prevention (CDC). Morb Mortal Wkly Rep. 2014:834-8.

Tukur J, Shittu SO, Abdul AM. A case control study of active genital chlamydia trachomatis infection among patients with tubal infertility in Northern Nigeria. Trop Doct. 2006;36(1):14-6.

World Health Organization. Infections, pregnancies and infertility: Perspectives and Prevention. Fertil Steril. 1987;47(6):964-8.

World Health Organization (WHO). Mother or nothing: The agony of infertility. WHO Bulletin. 2010;88:877-953.