Human Reproduction, Vol 12, 1464-1475, Copyright © 1997 by Oxford University Press
W Eggert-Kruse, G Rohr, T Demirakca, R Rusu, H Naher, D Petzoldt and B Runnebaum
The clinical significance of antichlamydial antibodies (Chlam Ab) was
determined in a total of 1303 subfertile couples consulting for infertility
investigation and treatment. Median age of the women was 30 (range 22-44)
years and of the men 33 (range 21-53) years. The median duration of
infertility was 4 (range 1-21) years. All patients were asymptomatic for
genital tract infection. A comprehensive infertility investigation included
examination of the endocrine, cervical, and tubal factor, and semen
analysis, antisperm antibody (ASA) testing, sperm-mucus interaction testing
in vitro using a standardized protocol, and post-coital testing (PCT).
Screening for Chlam IgG Ab was performed in serum of both partners,
obtained at the same time. Simultaneous microbial cultures in genital
secretions of both partners included a broad spectrum of potentially
pathogenic bacteria. Elevated titres of Chlam IgG Ab as seromarker for
previous infection were found in 20.8% of all women, and in 12.6% of men.
Chlam Ab were significantly more frequent in partners of seropositive
patients (in 51.8% of women with a Chlam Ab positive partner, compared to
15.8% of the other women). Microbial screening outcome was not
significantly related to results of chlamydial serology in both partners.
In women, elevated titres of Chlam Ab were significantly associated with a
tubal factor, but were not related to reduced quality of the endocervical
mucus (CM), including the in-vitro penetrability of the CM (using partners'
or donors' spermatozoa). In males, Chlam Ab were not significantly related
to the outcome of semen analysis, including screening for ASA (IgG and/or
IgA) in semen, and several parameters of sperm functional capacity. After
exclusion of couples with tubal disease, subsequent male fertility did not
significantly differ in males with or without Chlam Ab. The results suggest
that during basic infertility investigation, positive chlamydial serology
as an easy screening procedure indicates a higher risk for a tubal
infertility factor. However, in asymptomatic patients, Chlam IgG Ab in
serum are not associated with a cervical factor or with the male factor,
using several determinants for evaluation of semen quality including
subsequent fertilizing capacity.
ARTICLES
Chlamydial serology in 1303 asymptomatic subfertile couples
Department of Gynaecological Endocrinology and Reproductive Medicine, Women's University Hospital, Heidelberg, Germany.
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