Human Reproduction, Vol. 18, No. 12, 2621-2627,
December 2003
© 2003 European Society of Human Reproduction and Embryology
Performance of five serological chlamydia antibody tests in subfertile women
1 Department of Obstetrics and Gynaecology, 2 Department of Clinical Epidemiology and Medical Technology Assessment and 3 Department of Medical Microbiology, Academisch Ziekenhuis Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands
4 To whom correspondence should be addressed. e-mail: jlan{at}sgyn.azm.nl
BACKGROUND: Micro-immunofluorescence (MIF) is widely used for chlamydia antibody testing (CAT). Recently a species-specific MIF and three enzyme-linked immunosorbent assay (ELISA) tests have been introduced. We compared five commercially available CAT tests, using laparoscopy as a reference, and evaluated whether combinations of tests could improve the predictive value of CAT. METHODS: In a consecutive cohort of 315 subfertile women, results of the five CAT tests were correlated to findings at laparoscopy. Likelihood and odds ratios (OR) were calculated for single tests and for combinations of tests. RESULTS: Of the tests evaluated, MIF Labsystems had the best diagnostic performance (OR 15.7), while pELISA Medac (OR 8.2) was the best of the three ELISA tests. Stepwise logistic regression analysis showed that performance of MIF Labsystems could not be improved by adding a second test. Significant cross-reactivity with C. pneumoniae antibodies was found in all tests evaluated, except in pELISA Medac. CONCLUSIONS: In screening for tubal factor subfertility, MIF Labsystems was superior to the ELISA tests evaluated, and combining two CAT tests did not improve its predictive value. Economic analysis will show whether serial testing by pELISA Medac, and retesting positive samples by MIF Labsystems, is most cost-effective. In CAT, cross-reactivity with C. pneumoniae antibodies is still a major concern.
Key words: Chlamydia antibody test/diagnostic test/screening/serology/tubal infertility
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