AMSTERDAM — Women who test positive to Chlamydia trachomatis antibodies may face a longer road to conception than seronegative women, even if tubal pathology has been ruled out, according to a study of subfertile women in the Netherlands.
“In the Netherlands we use chlamydia antibody testing to triage infertility patients for tubal investigation,” Dr. Sjors Coppus said at the annual meeting of the European Society of Human Reproduction and Embryology.
But in such women, the absence of tubal pathology after hysterosalpingogram (HSG) or laparoscopic examination does not rule out potential fertility problems, said Dr. Coppus of the Academic Medical Center of the University of Amsterdam.
In an analysis of ovulatory subfertile women attending 38 clinics in the Netherlands, his study identified 1,882 who had undergone chlamydia antibody testing and tubal patency testing with either HSG or laparoscopy. The median age of the women was 33 years, they had experienced subfertility for a median duration of 1.9 years, and 38% of them were experiencing secondary subfertility. Of these women, 438 (23%) were seropositive and 1,444 (77%) were seronegative.
After 1 year of follow-up, 16% of the women had conceived spontaneously, and another 15% had conceived after receiving fertility treatment, for a cumulative pregnancy rate of 31%, reported Dr. Coppus. The rate of conception was similar in both seronegative and seropositive women at the 1-year mark; however, spontaneous conception occurred more quickly in the seronegative women (hazard ratio, 0.47).
“We can conclude that even after tubal pathology has been ruled out, if a woman is seropositive, she is approximately 50% less likely to conceive spontaneously within 1 year,” than a seronegative woman, he said. “This is a new prognostic factor in the treatment of subfertility.”