Role of IgG Chlamydia antibody in predicting tubal factor infertility

Dolly Johnrose; Geetha Raveendran; Sheila Balakrishnan; Anitha Malathy

doi:10.4103/jacm.jacm_54_16

ORIGINAL ARTICLE

Year : 2017 | Volume : 19 | Issue : 1 | Page : 32-35

Role of IgG Chlamydia antibody in predicting tubal factor infertility

Dolly Johnrose¹, Geetha Raveendran², Sheila Balakrishnan¹, Anitha Malathy¹
¹ Department of Obstetrics and Gynecology, Government Medical College, Thiruvananthapuram, Kerala, India
² Department of Microbiology, Government Medical College, Thiruvananthapuram, Kerala, India

Date of Web Publication

15-Jun-2017

Correspondence Address:
Geetha Raveendran
Department of Microbiology, Goverment Medical College, Manjeri, Malappuram - 676 121, Kerala
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jacm.jacm_54_16

Abstract

Background and Objectives: Infertility is not a health problem, but a serious psychological trauma that affects the social status of women in the society. Treatment of infertility imposes a heavy economic burden on the family. Infertility can be due to a single or combination of causes and identification of the cause is essential for the proper management. Chlamydia trachomatis is one of the most common causes of tubal factor infertility. No recent study has been done in Kerala to assess the burden of C. trachomatis in genitourinary infections. The aim of the study was to assess the role of C. trachomatis IgG antibody in patients with tubal factor infertility among women with primary or secondary infertility attending the fertility clinic in a tertiary care hospital in Kerala.
Materials and Methods: The study was done for one year and the sample size included 95 cases and 63 age-matched controls. Tubal disease was diagnosed by laparoscopy or hysterosalpingography. Serum samples of all the patients and controls were tested for C. trachomatis IgG antibodies by enzyme-linked immunosorbent assay.
Results: Of the 95 patients with tubal pathology, 14 (14.7%) had antibodies to C. trachomatis. Of the 63 patients with normal tubes, 12 (19%) had antibodies. However, of the 26 patients who were positive for Chlamydia antibodies, 14 (53.8%) had tubal disease.
Conclusions: The prevalence of Chlamydia IgG in our study among women attending fertility clinic for the treatment of primary or secondary infertility is 26/158 (16.5%). Fifty-one (81%) patients had normal tubes.

Keywords: Chlamydia trachomatis, IgG antibody, tubal infertility

How to cite this article:
Johnrose D, Raveendran G, Balakrishnan S, Malathy A. Role of IgG Chlamydia antibody in predicting tubal factor infertility. J Acad Clin Microbiol 2017;19:32-5

How to cite this URL:
Johnrose D, Raveendran G, Balakrishnan S, Malathy A. Role of IgG Chlamydia antibody in predicting tubal factor infertility. J Acad Clin Microbiol [serial online] 2017 [cited 2023 Feb 9];19:32-5. Available from: https://www.jacmjournal.org/text.asp?2017/19/1/32/208079

Introduction

Chlamydia trachomatis is a Gram-negative bacterium, one of the four species in the genus Chlamydia, which is further classified into two biovars – TRIC agents and agents causing lymphogranuloma venereum.

C. trachomatis infection is the most common bacterial sexually transmitted infections worldwide and women carry the major burden of the disease.^[1] The WHO 2005 prevalence estimates indicate that at any point in 2005, there were approximately 98 million adults infected with C. trachomatis globally of which 59 million were female in the age group of 15–49 years.^[2] It has been shown that developing countries have a high incidence of new Chlamydial infections. With the exception of sporadic testing for diagnostic and research purposes, Chlamydia screening is rarely done. No recent study has been done in Kerala to assess the burden of these genitourinary infections among infertile women. Hence, this study aims to assess the role of Chlamydia IgG antibody in patients with tubal factor infertility among women with primary or secondary infertility attending fertility clinics in a tertiary care hospital in Kerala.

Materials and Methods

Aim

The aim of this study was to evaluate the association of C. trachomatis IgG antibody with tubal infertility.

Design

This was a case–control study.

Settings

Fertility Clinic, Department of Obstetrics and Gynecology, Sree Avittom Thirunal Hospital, Government Medical College, Thiruvananthapuram, Kerala, India
Department of Microbiology, Government Medical College, Thiruvananthapuram.

Duration

The duration of the study was one year from February 1, 2015, to January 31, 2016.

Study population

Patients undergoing treatment for primary or secondary infertility with the presence of tubal disease diagnosed by laparoscopy were selected. The absence of free spill in one or both tubes, presence of peritoneal adhesions, hydrosalpinx or unhealthy appearance of the tubes were taken as evidence of tubal disease.

Controls

Patients who were being treated for primary or secondary infertility without tubal disease in laparoscopy were taken as controls.

The sample size was calculated as 95 cases and 95 controls with normal tubes (without any hydrosalpinx, peritoneal adhesions, absence of spill on one or both tubes or unhealthy appearance of tubes on laparoscopy).

The study was done after getting clearance from the Institutional Ethics Committee. Patients who came with a complaint of infertility were examined by gynaecologists and laparoscopy/hysterosalpingography was done to diagnose the cause. Informed written consent was obtained from all the patients with tubal pathology and from the designated number without tubal pathology.

From all the consenting selected patients, 5 ml of venous blood was drawn to detect Chlamydia IgG antibodies. The serum was separated and samples were stored at −70°C in the Department of Microbiology. Chlamydia IgG antibodies were detected by enzyme-linked immunosorbent assay (ELISA) (CT 054G-Calbiotech Inc.). The procedure in the product insert was followed.

Antibody index interpretation:

<0.9 – no detectable antibody
0.9–1.1 – borderline positive
>1.1 – detectable antibody.

All borderline samples were retested and confirmed.

Results

During this period, a total of 158 patients attended the fertility clinic. Of these, there were 95 patients with tubal pathology.

Of the 95 patients with tubal pathology on laparoscopy, 14 had IgG antibody to Chlamydia (14.7%). Of the 63 controls with normal tubes, 12 (19%) had Chlamydia antibody. The difference was not statistically significant (P = 0.474). However, of the 26 patients who were positive for Chlamydia antibodies, 14 patients (53.8%) had tubal pathology [Table 1].

Table 1: Age distribution of the patients

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Tubal disease was predominant in the age group of 26–35 years (75%) [Table 2].

Table 2: Chlamydia IgG positivity

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Of the 95 patients with abnormal tubes, 14 (14.7%) had antibodies to Chlamydia. Of the 63 patients with normal tubes, 12 (19%) had Chlamydia IgG antibodies [Table 3]a.

Table 3a: Type of infertility

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Of the 95 patients with tubal disease, 61 patients (64.2%) had primary infertility and 34 (35.8%) had secondary infertility [Table 3]b.

Of the 26 patients who were Chlamydia positive, 22 (84.6%) patients had primary infertility which was significant [Table 4].

Table 4: Socioeconomic status

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There was no significant difference in the socioeconomic status of patients with and without tubal disease.

Discussion

In the present study, the prevalence of C. trachomatis IgG antibodies among women with primary and secondary infertility was found to be 16.5% (26/158). This result is consistent with various studies worldwide and in India. Among women seeking health care for reproductive health complications, Chlamydia infection rates of 23.3%–33.3% have been reported from different parts of India.^[3] The prevalence of C. trachomatis in asymptomatic and symptomatic women attending a gynaecology clinic at New Delhi was 4% and 30.4%, respectively.^[4]

The risk factors include low socioeconomic status, multiple sexual partners and the use of intrauterine devices, while the protective factors are a higher age group and the use of oral and barrier contraceptives. In our study, there was no significant difference in the socioeconomic class between Chlamydia positive and negative patients.

Low, in 2008, reported rising rates of genital Chlamydial infections, but it is unclear if this is due to increased testing or a true increase in the incidence.^[5] Among young women attending STD clinics, rates are well above 10% as reported by van Bergen et al. in 2006.^[6]

Our study was done mostly on asymptomatic infertile women (10 patients had dysuria and six patients had tenderness on per vaginal examination) attending the fertility clinic, using ELISA to detect IgG antibodies indicating past infections and the prevalence was 17.6%. In a systematic review reported by Wilson et al., 2002, on C. trachomatis among asymptomatic European women, the prevalence ranged from 1.7% to 17% which is consistent with the result from our study.^[7] One hypothesis to explain subfertility in patients with normal tubes but positive Chlamydia antibodies is that intratubal microdamage may have resulted from a previous Chlamydia infection that cannot be detected with conventional patency tests such as hysterosalpingography or laparoscopy.^[8] Another hypothesis was the persistent C. trachomatis infection also elicits an autoimmune response to human heat shock proteins (HSPs) due to their structural similarity with Chlamydia HSP. Human HSPs play an important role in early pregnancy; animal as well as human research indicates that autoimmunity to human HSP exerts a negative influence on embryo development and implantation.^[9]

All the patients and their spouses were treated with Doxycycline 100 mg twice daily for 7 days and patients are on regular follow-up.

Conclusions

The prevalence of Chlamydia in our study among women attending fertility clinic for treatment of primary or secondary infertility is 16.5%
Tubal disease was predominant in the age group of 26–35 years (73%)
Of the 95 patients with tubal disease, 61 (64%) had primary infertility
Of the 63 patients with normal tubes, 12 had Chlamydia positivity. The difference is not significant
The absence of Chlamydia antibodies cannot be taken as a marker for normal tubes.

Recommendations

Chlamydia screening cannot be used as a predictor to pre-pone or post-pone laparoscopy in suspected patients of tubal factor infertility
As chlamydia has been shown to affect implantation, Chlamydia testing can be done before IVF and treatment given
Further studies are required to identify the exact role of Chlamydia in tubal factor infertility rather than secondary infertility.

Acknowledgement

This article is dedicated to the respected memory of our Former Principal, Dr. Ramdas Pisharody, who persuaded us to select this topic. We acknowledge the help provided by the staff in Fertility Clinic and Department of Microbiology, Government Medical College, Thiruvananthapuram.

Financial support and sponsorship

The research was financially supported by SAT endowment fund of Government Medical College, Thiruvananthapuram.

Conflicts of interest

There are no conflicts of interest.

References

1.	World Health Organization. Global prevalence and incidence of selected curable sexually transmitted diseases: Overview and estimates. Geneva: World Health Organization; 2011.
2.	Bébéar C, de Barbeyrac B. Genital Chlamydia trachomatis infections. Clin Microbiol Infect 2009;15:4-10.
3.	Sharma M, Nayak N, Malhotra S, Kumar B, Hemal A. Chlamydiazyme test for rapid detection of Chlamydia trachomatis. Indian J Med Res 1989;89:87-91.
4.	Ray K, Yadav SC. Prevalance of C. trachomatis and other sexually transmitted pathogens in female reproductive tract infections. Indian J Med Microbiol 1997;15:1-4.
5.	Low N. Screen project team. Publication of report on Chlamydia control activities in Europe. Euro Surveill 2008;13. pii: 18924.
6.	van Bergen J, Götz HM, Richardus JH, Hoebe CJ, Broer J, Coenen AJ; PILOT CT Study Group. Prevalence of urogenital Chlamydia trachomatis increases significantly with level of urbanisation and suggests targeted screening approaches: Results from the first national population based study in the Netherlands. Sex Transm Infect 2005;81:17-23.
7.	Wilson JS, Honey E, Templeton A, Paavonen J, Mårdh PA, Stray-Pedersen B; EU Biomed Concerted Action Group. A systematic review of the prevalence of Chlamydia trachomatis among European women. Hum Reprod Update 2002;8:385-94.
8.	Witkin SS. Immunity to heat shock proteins and pregnancy outcome. Infect Dis Obstet Gynecol 1999;7:35-8.
9.	Witkin SS, Sultan KM, Neal GS, Jeremias J, Grifo JA, Rosenwaks Z. Unsuspected Chlamydia trachomatis infection and in vitro fertilization outcome. Am J Obstet Gynecol 1994;171:1208-14.