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Hum. Reprod. Advance Access originally published online on June 24, 2008
Human Reproduction 2008 23(8):1840-1848; doi:10.1093/humrep/den237
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Screening strategies for tubal factor subfertility

J.E. den Hartog1,5, C.M.J.G. Lardenoije1, J.L. Severens2,3, J.A. Land1,4, J.L.H. Evers1 and A.G.H. Kessels2

1 Research Institute Growth and Development (GROW), Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands 2 Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands 3 Care and Public Health Research Institute (CAPHRI), Department of Health Organization, Policy and Economics, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands 4 Present address: Department of Obstetrics and Gynaecology, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands

5 Correspondence address. E-mail: je_denhartog{at}hotmail.com

BACKGROUND: Different screening strategies exist to estimate the risk of tubal factor subfertility, preceding laparoscopy. Three screening strategies, comprising Chlamydia trachomatis IgG antibody testing (CAT), high-sensitivity C-reactive protein (hs-CRP) testing and hysterosalpingography (HSG), were explored using laparoscopy as reference standard and the occurrence of a spontaneous pregnancy as a surrogate marker for the absence of tubal pathology.

METHODS: In this observational study, 642 subfertile women, who underwent tubal testing, participated. Data on serological testing, HSG, laparoscopy and interval conception were collected. Multiple imputations were used to compensate for missing data.

RESULTS: Strategy A (HSG) has limited value in estimating the risk of tubal pathology. Strategy B (CAT->HSG) shows that CAT significantly discerns patients with a high versus low risk of tubal pathology, whereas HSG following CAT has no additional value. Strategy C (CAT->hs-CRP->HSG) demonstrates that hs-CRP may be valuable in CAT-positive patients only and HSG has no additional value.

CONCLUSIONS: CAT is proposed as first screening test for tubal factor subfertility. In CAT-negative women, HSG may be performed because of its high specificity and fertility-enhancing effect. In CAT-positive women, hs-CRP seems promising, whereas HSG has no additional value. The position and timing of laparoscopy deserves critical reappraisal.

Key words: Chlamydia trachomatis/hysterosalpingography/screening/serological test/tubal factor subfertility

Submitted on August 6, 2007; resubmitted on March 25, 2008; accepted on May 26, 2008.


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