Chlamydia trachomatis IgG seropositivity is associated with lower natural conception rates in ovulatory subfertile women without visible tubal pathology

S. F P J Coppus, J. A. Land, B. C. Opmeer, P. Steures, M. J C Eijkemans, P. G A Hompes, P. M M Bossuyt, F. Van Der Veen, B. W J Mol, J. W. Van Der Steeg

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background The relation between Chlamydia trachomatis infection and subsequent tubal damage is widely recognized. As such, C. trachomatis antibody (CAT) testing can be used to triage women for immediate tubal testing with hysterosalpingography (HSG) or laparoscopy. However, once invasive tubal testing has ruled out tubal pathology, CAT serology status is ignored, as its clinical significance is currently unknown. This study aimed to determine whether positive CAT serology is associated with lower spontaneous pregnancy rates in women in whom HSG and/or diagnostic laparoscopy showed no visible tubal pathology. Methods We studied ovulatory women in whom HSG or laparoscopy showed patent tubes. Women were tested for C. trachomatis immunoglobulin G (IgG) antibodies with either micro-immunofluorescence (MIF) or an ELISA. CAT serology was positive if the MIF titre was <1:32 or if the ELISA index was >1.1. The proportion of couples pregnant without treatment was estimated at 12 months of follow-up. Time to pregnancy was considered censored at the date of the last contact when the woman was not pregnant or at the start of treatment. The association between CAT positivity and an ongoing pregnancy was evaluated with Cox regression analyses. Results Of the 1882 included women without visible tubal pathology, 338 (18) had a treatment-independent pregnancy within 1 year [estimated cumulative pregnancy rate 31; 95 confidence interval (CI): 2735]. Because of differential censoring after 9 months of follow-up, regression analyses were limited to the first 9 months after tubal testing. Positive C. trachomatis IgG serology was associated with a statistically significant 33 lower probability of an ongoing pregnancy [adjusted fecundity rate ratio 0.66 (95 CI 0.490.89)]. Conclusions Even after HSG or laparoscopy has shown no visible tubal pathology, subfertile women with a positive CAT have lower pregnancy chances than CAT negative women. After external validation, this finding could be incorporated into existing prognostic models.

LanguageEnglish
Pages3061-3067
Number of pages7
JournalHuman Reproduction
Volume26
Issue number11
DOIs
Publication statusPublished - 1 Jan 2011

Keywords

  • Chlamydia trachomatis
  • Fallopian tube patency test
  • treatment independent pregnancy
  • tubal pathology

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

Cite this

Coppus, S. F. P. J., Land, J. A., Opmeer, B. C., Steures, P., Eijkemans, M. J. C., Hompes, P. G. A., ... Van Der Steeg, J. W. (2011). Chlamydia trachomatis IgG seropositivity is associated with lower natural conception rates in ovulatory subfertile women without visible tubal pathology. Human Reproduction, 26(11), 3061-3067. https://doi.org/10.1093/humrep/der307
Coppus, S. F P J ; Land, J. A. ; Opmeer, B. C. ; Steures, P. ; Eijkemans, M. J C ; Hompes, P. G A ; Bossuyt, P. M M ; Van Der Veen, F. ; Mol, B. W J ; Van Der Steeg, J. W. / Chlamydia trachomatis IgG seropositivity is associated with lower natural conception rates in ovulatory subfertile women without visible tubal pathology. In: Human Reproduction. 2011 ; Vol. 26, No. 11. pp. 3061-3067.
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abstract = "Background The relation between Chlamydia trachomatis infection and subsequent tubal damage is widely recognized. As such, C. trachomatis antibody (CAT) testing can be used to triage women for immediate tubal testing with hysterosalpingography (HSG) or laparoscopy. However, once invasive tubal testing has ruled out tubal pathology, CAT serology status is ignored, as its clinical significance is currently unknown. This study aimed to determine whether positive CAT serology is associated with lower spontaneous pregnancy rates in women in whom HSG and/or diagnostic laparoscopy showed no visible tubal pathology. Methods We studied ovulatory women in whom HSG or laparoscopy showed patent tubes. Women were tested for C. trachomatis immunoglobulin G (IgG) antibodies with either micro-immunofluorescence (MIF) or an ELISA. CAT serology was positive if the MIF titre was <1:32 or if the ELISA index was >1.1. The proportion of couples pregnant without treatment was estimated at 12 months of follow-up. Time to pregnancy was considered censored at the date of the last contact when the woman was not pregnant or at the start of treatment. The association between CAT positivity and an ongoing pregnancy was evaluated with Cox regression analyses. Results Of the 1882 included women without visible tubal pathology, 338 (18) had a treatment-independent pregnancy within 1 year [estimated cumulative pregnancy rate 31; 95 confidence interval (CI): 2735]. Because of differential censoring after 9 months of follow-up, regression analyses were limited to the first 9 months after tubal testing. Positive C. trachomatis IgG serology was associated with a statistically significant 33 lower probability of an ongoing pregnancy [adjusted fecundity rate ratio 0.66 (95 CI 0.490.89)]. Conclusions Even after HSG or laparoscopy has shown no visible tubal pathology, subfertile women with a positive CAT have lower pregnancy chances than CAT negative women. After external validation, this finding could be incorporated into existing prognostic models.",
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Coppus, SFPJ, Land, JA, Opmeer, BC, Steures, P, Eijkemans, MJC, Hompes, PGA, Bossuyt, PMM, Van Der Veen, F, Mol, BWJ & Van Der Steeg, JW 2011, 'Chlamydia trachomatis IgG seropositivity is associated with lower natural conception rates in ovulatory subfertile women without visible tubal pathology', Human Reproduction, vol. 26, no. 11, pp. 3061-3067. https://doi.org/10.1093/humrep/der307

Chlamydia trachomatis IgG seropositivity is associated with lower natural conception rates in ovulatory subfertile women without visible tubal pathology. / Coppus, S. F P J; Land, J. A.; Opmeer, B. C.; Steures, P.; Eijkemans, M. J C; Hompes, P. G A; Bossuyt, P. M M; Van Der Veen, F.; Mol, B. W J; Van Der Steeg, J. W.

In: Human Reproduction, Vol. 26, No. 11, 01.01.2011, p. 3061-3067.

Research output: Contribution to journalArticle

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T1 - Chlamydia trachomatis IgG seropositivity is associated with lower natural conception rates in ovulatory subfertile women without visible tubal pathology

AU - Coppus, S. F P J

AU - Land, J. A.

AU - Opmeer, B. C.

AU - Steures, P.

AU - Eijkemans, M. J C

AU - Hompes, P. G A

AU - Bossuyt, P. M M

AU - Van Der Veen, F.

AU - Mol, B. W J

AU - Van Der Steeg, J. W.

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N2 - Background The relation between Chlamydia trachomatis infection and subsequent tubal damage is widely recognized. As such, C. trachomatis antibody (CAT) testing can be used to triage women for immediate tubal testing with hysterosalpingography (HSG) or laparoscopy. However, once invasive tubal testing has ruled out tubal pathology, CAT serology status is ignored, as its clinical significance is currently unknown. This study aimed to determine whether positive CAT serology is associated with lower spontaneous pregnancy rates in women in whom HSG and/or diagnostic laparoscopy showed no visible tubal pathology. Methods We studied ovulatory women in whom HSG or laparoscopy showed patent tubes. Women were tested for C. trachomatis immunoglobulin G (IgG) antibodies with either micro-immunofluorescence (MIF) or an ELISA. CAT serology was positive if the MIF titre was <1:32 or if the ELISA index was >1.1. The proportion of couples pregnant without treatment was estimated at 12 months of follow-up. Time to pregnancy was considered censored at the date of the last contact when the woman was not pregnant or at the start of treatment. The association between CAT positivity and an ongoing pregnancy was evaluated with Cox regression analyses. Results Of the 1882 included women without visible tubal pathology, 338 (18) had a treatment-independent pregnancy within 1 year [estimated cumulative pregnancy rate 31; 95 confidence interval (CI): 2735]. Because of differential censoring after 9 months of follow-up, regression analyses were limited to the first 9 months after tubal testing. Positive C. trachomatis IgG serology was associated with a statistically significant 33 lower probability of an ongoing pregnancy [adjusted fecundity rate ratio 0.66 (95 CI 0.490.89)]. Conclusions Even after HSG or laparoscopy has shown no visible tubal pathology, subfertile women with a positive CAT have lower pregnancy chances than CAT negative women. After external validation, this finding could be incorporated into existing prognostic models.

AB - Background The relation between Chlamydia trachomatis infection and subsequent tubal damage is widely recognized. As such, C. trachomatis antibody (CAT) testing can be used to triage women for immediate tubal testing with hysterosalpingography (HSG) or laparoscopy. However, once invasive tubal testing has ruled out tubal pathology, CAT serology status is ignored, as its clinical significance is currently unknown. This study aimed to determine whether positive CAT serology is associated with lower spontaneous pregnancy rates in women in whom HSG and/or diagnostic laparoscopy showed no visible tubal pathology. Methods We studied ovulatory women in whom HSG or laparoscopy showed patent tubes. Women were tested for C. trachomatis immunoglobulin G (IgG) antibodies with either micro-immunofluorescence (MIF) or an ELISA. CAT serology was positive if the MIF titre was <1:32 or if the ELISA index was >1.1. The proportion of couples pregnant without treatment was estimated at 12 months of follow-up. Time to pregnancy was considered censored at the date of the last contact when the woman was not pregnant or at the start of treatment. The association between CAT positivity and an ongoing pregnancy was evaluated with Cox regression analyses. Results Of the 1882 included women without visible tubal pathology, 338 (18) had a treatment-independent pregnancy within 1 year [estimated cumulative pregnancy rate 31; 95 confidence interval (CI): 2735]. Because of differential censoring after 9 months of follow-up, regression analyses were limited to the first 9 months after tubal testing. Positive C. trachomatis IgG serology was associated with a statistically significant 33 lower probability of an ongoing pregnancy [adjusted fecundity rate ratio 0.66 (95 CI 0.490.89)]. Conclusions Even after HSG or laparoscopy has shown no visible tubal pathology, subfertile women with a positive CAT have lower pregnancy chances than CAT negative women. After external validation, this finding could be incorporated into existing prognostic models.

KW - Chlamydia trachomatis

KW - Fallopian tube patency test

KW - treatment independent pregnancy

KW - tubal pathology

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U2 - 10.1093/humrep/der307

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JO - Human Reproduction

T2 - Human Reproduction

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