Chlamydia antibody titre as a predictor of tubal factor infertility

Abstract

BACKGROUND: Genital Chlamydia trachomatis is major cause of tubal factor infertility. Assessment of tubal patency by hysterosalpingography (HSG) and laparoscopy are invasive and expensive.  In low resource setting, there may be a place for Chlamydia Antibody Titre (CAT) in infertility work up.
Objective: To determine the predictive value of Chlamydia antibody titre in tubal factor infertility.
Materials and Methods: This was a prospective cross-sectional study of women presenting with infertility at the Human Reproduction Research Programme unit of the University of Benin Teaching Hospital, Benin City, Nigeria. All the women had serum Chlamydia antibody titre and hysterosalpingography and where indicated, laparoscopy and dye test. The predictive value of Chlamydia Antibody was assessed using likelihood ratios.
Results: The prevalence of Chlamydia antibody among women with infertility was 32.1%. This was significantly higher among women with HSG diagnosed tubal damage (72.1% vs 27.9%; P = 0.000). The sensitivity and specificity of Chlamydia Antibody were 84.6% and 66.7% respectively while the sensitivity and specificity of Hysterosalpingogram were 85.7% and 50% respectively. The positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of CAT were 2.58 and 0.22 respectively while the LR+ and LR- of HSG were 1.72 and 0.28 respectively. Both tests showed comparable predictive value in screening for tubal damage.
Conclusions: The predictive value of CAT was comparable to that of HSG. Chlamydia antibody titre determination is non-invasive and inexpensive and may be used in infertility screening to select patient for HSG and laparoscopy.