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Tubal damage in infertile women: prediction using chlamydia serology
Valentine A Akande1, Linda P Hunt, David J Cahill
1University Division of Obstetrics and Gynaecology, St Michael's Hospital, Bristol BS2 8EG, UK. valentine.akande@bristol.ac.uk
Background:
The study explores the relationship between serum chlamydia antibody titres (CATs) and detection of tubal damage in infertile women.
Methods:
The tubal status and pelvic findings in 1006 women undergoing laparoscopy for infertility were related to CAT, which was measured using the whole-cell inclusion immunofluorescence test.
Results:
A negative correlation between CAT and age was noted. A linear trend between serum CAT and the likelihood of tubal damage, including severe damage, was observed (P < 0.001). Titres in women with tubal damage (median 1:1024; range <1:64-1:4096) were significantly (P < 0.001) higher than in women with endometriosis alone (median <1:64; range <1:64-1:512) or those with a normal pelvis (median <1:64; range <1:64-1:1024). Women with positive titres were more likely to have pelvic adhesions than tubal occlusion unless titres were very high, when tubal damage was likely to be more severe.
Conclusions:
CATs are of predictive value in the detection of tubal damage and are quantitatively related to the severity of damage. For practical clinical purposes, Chlamydia serology is useful mainly as a screening test for the likelihood of tubal damage in infertile women and may facilitate decisions on which women should proceed with further investigations without delay.