Robotic surgery for tubal anastomosis was successfully accomplished without conversion to laparotomy. The robotic technique for tubal anastomosis required significantly prolonged surgical and anesthesia times over outpatient minilaparotomy (P

Objective To identify Chlamydia trachomatis antigens associated with tubal factor infertility and acute infection. Methods A C. trachomatis proteome array was used to compare antibody profiles among women with tubal factor infertility, normal fertility, and acute C. trachomatis infection. Results Thirteen immunodominant antigens reacted with 50% or more sera from all women (N=73). Six C. trachomatis antigens were uniquely recognized by women diagnosed with tubal factor infertility. Combining fragmentation of the six antigens with serum sample dilution, chlamydial antigens HSP60, CT376, CT557, and CT443 could discriminate between women with tubal factor infertility and women with normal fertility with a sensitivity of 63% (95% CI: 0.41–0.77) and specificity of 100% (95% CI: 0.91–1), respectively. These antigens were designated as tubal factor infertility-associated antigens. However, these tubal factor antigens were unable to distinguish tubal factor infertility patients from those with acute infection. A combination of CT875 and CT147 distinguished women with acute infection from all other C. trachomatis-exposed women with a detection sensitivity of 63% (95% CI: 0.41–0.77) and specificity of 100% (95% CI: 0.95–1), respectively. Thus, CT875 and CT147 were designated as acute infection-associated antigens. Conclusion A sequential screening of antibodies against panels of C. trachomatis antigens can be used to identify women with tubal factor infertility and acute C. trachomatis infection.

OBJECTIVE The objective of the study was to assess antibodies against Chlamydia trachomatis heat shock proteins (HSP) in patients with tubal factor infertility (TFI), infertility controls (IFC), and fertile controls (FC). HSPs assist organisms in surviving caustic environments such as heat. STUDY DESIGN Twenty-one TFI, 15 IFC, and 29 FC patients were enrolled after laparoscopic tubal assessment. The titers of antibodies against C trachomatis organisms and 14 chlamydial HSPs were compared among the 3 groups. RESULTS TFI patients developed significantly higher levels of antibodies against C trachomatis and specifically recognizing chlamydial HSP60 and caseinolytic protease (Clp) P, a subunit of the ATP-dependent Clp protease complex involved in the degradation of abnormal proteins. CONCLUSION In addition to confirming high titers of antibodies against C trachomatis organisms and HSP60 in TFI patients, we identified a novel link of TFI with anti-ClpP antibodies. These findings may provide useful information for developing a noninvasive screening test for TFI and constructing subunit anti-C trachomatis vaccines.

Objective To identify C. trachomatis antigens that can be used to differentially diagnose tubal factor infertility in comparison to previously reported Heat Shock Protein 60 (HSP60). Design In Vitro Study Patients Infertile women with and without tubal pathology diagnosed laparoscopically. Setting Academic medical center. Main Outcome Measures Antibody responses to C. trachomatis in infertile women with or without tubal pathologies using a C. trachomatis genome-wide proteome array. Results Comparison of the antibody profiles revealed 30 C. trachomatis antigens that were preferentially recognized by tubal factor infertility women with a detection sensitivity and specificity of 80.6% and 56.5%, respectively, 10 of which showed 100% specificity. A combination of CT443 and CT381 antigens yielded the highest detection sensitivity (67.7%) while maintaining 100% specificity. Conclusion These findings have demonstrated that antibodies to CT443 and CT381, when used in combination, have higher sensitivity and specificity in predicting tubal factor infertility than other indicators for tubal factor infertility such as HSP60 antibodies (35.5%, 100%) or hysterosalpingogram (65%, 83%). Using a panel of C. trachomatis antigens to serologically diagnose tubal factor infertility can save the patients from undertaking expensive and invasive procedures for determining tubal pathology and choosing treatment plans.

Objectives To examine risk factors for prevalence and incidence of pelvic organ prolapse (POP) in whites, Hispanics, and blacks. Methods This is a secondary analysis of the Women’s Health Initiative (WHI) Estrogen plus Progestin Clinical Trial. Out of the original E+P trial population of 16,608, 12,667 (78.3%) women (11,194 Whites, 804 Blacks, 669 Hispanics) were included in the final study sample and evaluated over the 5 year period. The outcomes evaluated were any prolapse (WHI Prolapse Grades 1–3) and WHI Prolapse Grades 2 or 3. Descriptive analyses, logistic regression and proportional hazard meodeling were performed. Results Increasing parity correlates with increasing WHI Prolapse Grades (0–3) in Whites and Blacks but not Hispanics. The incidence of Grade 2/3 POP increased by 250% in white women with one child (HR 2.50, 1.68–3.71) in comparison to nulliparous women and grew with higher parity. For Blacks, a weak association between the parity and Grade 2/3 POP was noted only in women who had 5 or more kids (HR 10.41, 1.38–78.77). Blacks were less likely (HR 0.53, 0.40–0.71) to develop Grade 2/3 POP compared to whites. For Grade 2/ 3 POP, age was found to be a risk factor in whites (OR 1.03, 1.02–1.04) only and BMI (≥25kg/m2, <30kg/m2) in whites (OR 1.64, 1.34–2.02) and Hispanics (OR 2.87, 1.03–2.02). Conclusions White women are at a much greater risk for developing Grade 2/3 POP compared to blacks. Parity correlates most strongly with the risk of prolapsed development in whites and possibly in grand multiparous blacks.

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