Chlamydial serology and histerosalpingography in predicting tubal disease in infertility patients.

Abstract

To evaluate the role of Chlamydial serology and hysterosalpingography (HSG) in predicting tubal disease, alone or combined with versus laparoscopy, which is known to be the gold standard but an invasive procedure. In 135 patients who suffered from infertility for at least 2 years admitted to Zeynep Kamil Women and Children's Hospital, Department of Infertility between January 5, 1993 to March 18, 1995. Chlamydial antibody titers were measured, HSG were performed. Tubal disease was identified by laparoscopy. 19 patients with endometriosis and 22 patients who could not be followed were excluded from study group. The final study group comprised 94 patients who had antibody titers, HSG laparoscopy. Sensitivity, specificity, positive and negative predictive values of each diagnostic test were calculated, differences in proportions and means were calculated using chi 2 test and analysis of variance, respectively. For HSG, sensitivity was 88.9%, specificity was 78%, positive predictive value (PPV) was 71% and negative predictive value (NPV) was 92%. For chlamydial antibody titers, sensitivity was 52%, specificity was 68%, PPV was 37% and NPV was 80%. For both HSG and Chlamydial antibody titers, sensitivity was 34%, specificity was 64%, PPV was 36% and NPV was 62%. In our study population 35 (37%) of the infertile women had tubal factor identified by laparoscopy and 37% of these had positive Chlamydial antibody titers. These findings indicate that in our population tubal factor has an important place among causes of infertility but in its etiology Chlamydial infection does not seem to play a major role contrary to previous reports. This can be explained by lower incidence of Chlamydial infections due to infrequency of multipartner sexual relationships and advanced age of first intercourse among women in society. Measurement of antibody titers neither by itself nor in Combination with HSG were not found to be cost-effective and beneficial. We propose conventional HSG as a single, cost-effective procedure since it is also almost as predictive as laparoscopy in detecting tubal disease among our infertile population.