ABSTRACT
The purpose was to investigate the prevalence of Chlamydia trachomatis antibodies in the sera of infertile patients and to compare the diagnostic value of Chlamydia trachomatis antibody testing versus hysterosalpingography [HSG] in predicting tubal factor infertility. The study included 100 patients with primary infertility with no history of pelvic surgery or pelvic inflammatory disease. Patients were tested for Chlamydia trachomatis IgG antibody by an indirect microimmunofluoresence antibody technique. Hysterosalpingography [HSC] and laparoscopy were performed for all patients. An antibody titer of 1/8 was judged seropositive. Likelihood ratios [LRS] were used to compare the diagnostic value of Chlamydia trachomatis antibody testing with that of HSG in predicting tubal factor infertility. Twenty-four percent of patients were seropositive for Chlamydia trachomatis antibody, 18 of the seropositive patients [75%] had tuboperitoneal disease at laparoscopy, of the 76 seronegative patients only 4 [5.2%] had tuboperitoneal disease, a statistically highly significant difference [P < 0.0001]. The likelihood of the tuboperitoneal disease increased with the height of the titer. Both Chlamydia antibody testing and HSG had equal positive likelihood ratio of 8 indicating that a patient with tubal factor infertility to be 8 times more like to have positive serology and abnormal HSG than a patient without tubal factor infertility. Chlamydia antibody testing, however, had a higher sensitivity and lower negative likelihood ratio than HSG. The results of this study suggest that Chlamydia trachomatis plays an important role in tubal factor infertility in our community. In certain infertility population it compares well and even performs better than HSG in predicting that type of infertility. Chlamydia antibody testing is a simple and convenient test and should become a key part of the initial diagnostic work-up for infertile women