ABSTRACT
ObjectiveTo further study the pathogenic role of different types of Chlamydia trachomatis （CT） proteins in tubal factor infertility， evaluate the clinical detection value of Chlamydia trachomatis protein antibody in predicting tubal factor infertility. MethodsA total of 58 cases of tubal factor infertility （TFI）， 41 cases of fertile controls （FC） and 18 cases of infertile controls （IFC） were included. For serum detection， first， CT-IgG ELISA kit was used to detect the expression of CT-IgG in serum of three groups of people； then， 6 kinds of Chlamydia trachomatis proteins were expressed and purified in the early stage to establish the antibody test for these proteins， and ELISA detection method was used to detect the expression of their antibodies in the serum of TFI group， FC group and IFC group， respectively； and finally， the antibody OD value of the 6 kinds of Chlamydia trachomatis proteins in the three groups of subjects were statistically described， and CT-IgG was used as the reference standard to draw the receiver operating characteristic curve （ROC curve） of each CT antibody. The Youden Index determines the cutoff value for each antibody. Taking TFI as the reference class， two disordered multiple classification logistic regression models were established with the FC and IFC groups， respectively； and the reference class was used to explore the value of various antibodies and age in predicting TFI， FC and IFC of Chlamydia trachomatis. The back-off method was used to screen the variables. ResultsThe OD value of CT376 antibody in the TFI group was higher than that in the FC group （0.86 vs. 0.60， P=0.026）. The CT376 antibody OD value in the TFI group was higher than that in the IFC group （0.86 vs. 0.64， P=0.026）. The CT443 antibody OD value in the IFC group was higher than that in the TFI group （0.59 vs. 0.34， P=0.036） and higher than that in the FC group （0.59 vs. 0.30， P=0.02）. The multiple classification logistic regression analysis established between TFI and FC showed that CT-IgG ［P<0.001， OR=0.084， 95%CI （0.025， 0.284）］， CT376 antibody ［P=0.068， OR=0.359， 95%CI （0.120， 1.078）］. CT-IgG is an independent risk factor for tubal infertility， and CT376 antibody cannot be an independent risk factor for tubal infertility. The multiple classification logistic regression analysis established between TFI and IFC showed that among infertile patients， CT-IgG ［P<0.05， OR=0.194， 95%CI （0.046， 0.817）］， CT376 antibody ［P<0.05， OR=0.176， 95%CI （0.038， 0.818）］ and CT381 antibody ［P<0.05， OR=0.112， 95%CI （ 0.016， 0.796）］ were independent risk factors for tubal infertility. ConclusionThe expression of CT376 antibody in tubal infertility patients is higher than that in fertile and infertile controls， suggesting that CT-induced tubal factor infertility may be related to CT376. CT-IgG， and CT376 antibodies are meaningful in predicting CT-induced tubal factor infertility.
ABSTRACT
Abstract The impact of Chlamydia trachomatis (CT) infection on female's fertility is not completely established yet, since the level of evidence associating these factors is still weak. Hence, the goal of the present review is to contribute to a better elucidation of this matter. The electronic database chosen was the Medline/PubMed, with the last survey on May 11, 2021. Publication date was used as a filter, with the previous 5 years having been selected. The following describers were used: chlamydia trachomatis AND infertility; chlamydia trachomatis AND tubal alteration AND infertility; chlamydia AND low pregnancy rates. From the 322 studies screened, 293 that failed to meet our eligibility criteria were excluded. Subsequently, we removed seven studies for not having the possible correlation between CT infections and female infertility as its main focus, and three for being about sexually transmitted infections (STIs) in general. Moreover, two studies designed as reviews were also excluded. Ergo, we included 17 studies in our qualitative analysis. The authors conducted research individually and analyzed carefully the studies selected. As we retrieved the information needed for our study through reading the texts, no contact was made with the authors of the studies selected. This systematic review corroborates the hypothesis that CT infection potentiates female infertility, as 76.47% of the included studies found a positive correlation between them. We conclude that there is an important association between CT infection and female infertility. Ergo, making CT screening part of the infertility investigation routine is relevant and has a reasonable justification.
Resumo O impacto da infecção por Chlamydia trachomatis (CT) na fertilidade feminina ainda não está completamente estabelecido, uma vez que o nível de evidência associando esses fatores ainda é insignificante. Assim, o objetivo desta revisão é contribuir para uma melhor elucidação deste assunto. A base de dados eletrônica escolhida foi a Medline/PubMed, com a última pesquisa em 11 de maio de 2021. Utilizou-se como filtro a data de publicação, sendo selecionados os 5 anos anteriores. Foram usados os seguintes descritores: Chlamydia trachomatis E infertility; Chlamydia trachomatis E tubal alteration E infertility; Chlamydia E low pregnancy rates. Dos 322 estudos selecionados, 293 que não atenderam aos nossos critérios de elegibilidade foram excluídos. Posteriormente, retiramos sete estudos por não terem como foco principal a possível correlação entre infecção por CT e infertilidade feminina e três por tratarem de infecções sexualmente transmissíveis (ISTs) em geral. Além disso, dois estudos concebidos como revisões também foram excluídos. Portanto, incluímos 17 estudos em nossa análise qualitativa. Os autores realizaram pesquisas individualmente e analisaram criteriosamente os estudos selecionados. Como obtivemos as informações necessárias para nosso estudo por meio da leitura dos textos, nenhum contato foi feito com os autores. Esta revisão sistemática corrobora a hipótese de que a infecção por CT potencializa a infertilidade feminina, pois 76,47% dos estudos incluídos encontraram correlação positiva entre eles. Concluímos que existe uma associação importante entre infecção por CT e infertilidade feminina. Portanto, tornar os procedimentos de triagem por CT parte da rotina de investigação de infertilidade é relevante e justificável.
Subject(s)
Humans , Female , Pregnancy, Tubal , Sexually Transmitted Diseases , Chlamydia trachomatisABSTRACT
Background: Failure to achieve conception after 12 months of regular unprotected intercourse is defined as infertility. The aim of this study was evaluating SIS done under high pressure (SIStreat) as a treatment procedure, for relieving simple tubal obstruction and on cumulative pregnancy rate in infertile women.Methods: A prospective, interventional trial was done (October 2017 - November 2018) on 106 eligible women. All patients performed SIS. Patient with tubes patent under low pressure were assigned as control group, the rest of them were subjected to SIStreat, this group was farther divided into Group 2-a (patent under high pressure) and Group 2-b (occluded under high pressure). All patients had regular intercourse for 6 months. Pregnancy was confirmed by serum B-HCG.Results: we compared patients who performed conventional SIS (n = 100 cases) to patients who performed SIStreat afterwards (n = 84) according to the number of patent tubes. There was a high statistically significant difference in favor of SIStreat group (p < 0.001). Also, there was no significant difference in pregnancy rate between control group 62.5% and Group 2-a 45.7% (p = 0.226).Conclusions: SIStreat is a whole new procedure for opening fallopian tubes (diagnosed occluded by SIS). Patients who were successfully treated by SIStreat had cumulative pregnancy rate comparable to patients who were diagnosed to have patent tubes using conventional SIS.
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Background: Infertility is defined as inability to conceive within one or more years of regular unprotected coitus. Infertility has now a days not only a medical but a social problem as well. Ignorance and illiteracy, coupled with hesitancy to discuss the problem, complicates the matter further. WHO has listed infertility as a global health issue.Methods: The present study was conducted on 64 patients with female factor primary infertility admitted in department of obstetrics and gynecology at Rajendra Hospital, Patiala over a duration of 1 year (December 2013- November 2014). All the patients had normal semen study of their partner.Results: In our study mean age was 27.87±4.57. No patient was above 40 years of age. Duration of infertility between 1-5 years was in 47 patients (73.43%), nine patients (14.06%) were infertile for 6-10 years. Out of 64 patients of primary infertility, majority of patients were of endometriosis 15(23.43%), followed by pelvic inflammatory disease14(21.87%), tubal blockade in 7(10.9%), PCOD in 6(9.37%). 14.08% patients had normal laproscopic study. 34 patients (53.12%) had bilateral spill while no spill was seen in 12 patients (18.75%). Unilateral spill was seen in seven patients (10.93%) while six patients (9.37%) had delayed spill.Conclusions: Prevalence of infertility is increasing, so is the awareness and treatment seeking behavior. The present study assures that in evaluation and workup of primary infertility patients, after baseline noninvasive investigations, endometrial sampling and HSG, the diagnostic and operative laproscopy is an excellent tool for evaluation of tubal factor. Least expected conditions like endometriosis on clinical evaluation, can be diagnosed and treated with ease on laproscopy. Although tubal factor has been considered to be responsible for a large percentage of cases with female secondary infertility since decades, but in present study laproscopic evaluation confirmed tubal factor in 85.01% cases with female factor infertility.
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OBJECTIVE: To find risk factors for ectopic pregnancy among women who conceived after fresh non-donor in vitro fertilization and embryo transfer (IVF-ET). METHODS: A total of 2,326 cycles conceived after fresh non-donor IVF-ET between January 2002 and December 2005 were studied with regard to patient factors, and factors related to the ART procedures through review of their medical chart. Risk factors in ectopic pregnancy were assessed by using chi-square test and multivariate logistic regression analysis. RESULTS: Of 2,326 pregnancies of fresh non-donor IVF-ET cycles, 135 (5.8%) were ectopic pregnancies. Most of ectopic pregnancies were tubal type (79 cases, 58.5%) and combined type (40 cases, 29.6%). Most of ectopic pregnancies (87.4%) were treated by laparoscopic surgery. In comparison with clinical pregnancy group, estradiol level checked on human chorionic gonadotrophin (hCG) injection day for final follicular maturation and mean number of oocytes retrived were higher in ectopic group. respectively, (2,228.9 vs. 1,906.9 pg/ml, p=0.022; 13.8 vs. 11.6, p=0.001). In univariate analysis, the risk for ectopic pregnancy was increased among women with tubal factor infertility (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.20-2.35) and, decreased among women with male factor infertility (OR 0.7, 95% CI 0.47-0.94) and use of intracytoplasmic sperm injection (ICSI) (OR 0.7, 95% CI 0.50-0.98). However, in multivariate logistic regression analysis, only tubal factor was an independent predictor for ectopic pregnancy. CONCLUSIONS: Tubal factor infertility is the main risk factor for ectopic pregnancy following fresh non-donor IVF-ET.