How to use Chlamydia antibody testing in subfertility patients

The results reported, are heterogeneous, and no uniformity exists in cut-off levels of titres, or in definitions of tubal factor subfertility

J. A. Land; J. L. Evers; V. J. Goossens

2002

Scholarcy highlights

  • Chlamydiaceae are Gram-negative coccoid micro-organisms that have a unique, obligately intracellular development cycle
  • C. trachomatis has been subdivided into 15 serotypes, which are grouped according to their clinical expression: serotypes A–C are associated with ocular disease, serotypes D–K with genital infections and L1–L3 with lymphogranuloma venereum
  • Since it was noted that the development of pelvic inflammatory disease and its chronic sequelae are associated with Chlamydia IgG-antibody formation, the relation between antibody titres and tubal factor subfertility has been demonstrated in many studies using immunofluorescence tests, or enzyme-linked immunosorbent assay
  • The results reported in literature on screening for tubal factor subfertility by Chlamydia antibody testing, are heterogeneous
  • Clinicians have searched for simple and inexpensive screening tests to estimate the risk of tubal factor subfertility in a particular patient, in order to subject a high risk patient to diagnostic testing, and to postpone additional testing in a low risk patient
  • The area under the curve in the received operating characteristic curve representing definition 1 is 0.65; for definition 2, 0.70; for definition 3, 0.76; and for definition 4, 0.80
  • Proximal tubal occlusion, which usually is of non-Chlamydia origin, cannot be adequately predicted from C. trachomatis antibody titres
  • The prediction of a patient not having tubal factor subfertility related to Chlamydia is more accurate at a cut-off level of 16 or 32 as compared to 64

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