Predicting tubal factor infertility by using markers of humoral and cell‐mediated immune response against Chlamydia trachomatis

Abstract

Problem The accuracy of Chlamydia trachomatis antibody test in predicting tubal factor infertility (TFI) is limited, and more accurate methods are needed. Cell‐mediated immune response (CMI) is crucial in the resolution of pathogen, but it may play an important role in the pathogenesis of C trachomatis‐associated tubal damage. We studied whether combining the markers of C trachomatis‐induced CMI to humoral immune response improves the accuracy of serology in TFI prediction. Method of study Our prospective study consists of 258 subfertile women, of whom 22 (8.5%) had TFI. Women with other causes for subfertility served as a reference group. Serum C trachomatis major outer membrane protein (MOMP) and chlamydial heat‐shock protein 60 (cHSP60) IgG antibodies were measured by ELISA. CMI was studied by lymphocyte proliferation assay in vitro. Results Serological markers were more prevalent in women with TFI than in other subfertile women (40.9% vs 12.3% for MOMP IgG and 27.3% vs 10.2% for cHSP60 IgG). The best test combination for TFI was C. trachomatis MOMP and cHSP60 antibody with an accuracy of 90.3%, sensitivity of 22.7% and specificity of 96.6%. Positive post‐test probability of this combination was 54.2%, and negative post‐test probability was 12.4%. Adding of the markers of CMI did not significantly improve the accuracy of serology in TFI prediction. Conclusion The accuracy of TFI prediction increases when the combination of C trachomatis MOMP and cHSP60 antibody tests is used. C trachomatis‐induced CMI was common in our study population, but the markers of CMI did not predict TFI.

Chlamydia trachomatis‐induced cell‐mediated and humoral immune response in women with unexplained infertility

“…The presence of serum antichlamydial antibodies or positive LP response to C. trachomatis in women with unexplained infertility had no impact on overall pregnancy rate or live birth rate during the follow-up. This finding is in line with our previous study, where the best immunological marker in identifying women with TFI was C. trachomatis IgG antibody and adding the result of cell-mediated immune response did not significantly improve the likelihood of TFI 13. This suggests that in some women, past C. trachomatis infection may impair the chance for natural conception, even without causing TFI.Tubal function may be impaired, although there is no visible tubal occlusion.…”

“…13 The assay sensitivity and specificity for C. trachomatis were 99% and 65%, respectively. Serum IgG antibodies specific to C. trachomatis were analyzed using major outer membrane protein (MOMP) peptide-based ELISA (Medac Diagnostica, Hamburg, Germany) according to manufacturer's instruction.…”

“…Serum IgG antibodies specific to C. trachomatis were analyzed using major outer membrane protein (MOMP) peptide-based ELISA (Medac Diagnostica, Hamburg, Germany) according to manufacturer's instruction. 13 The assay sensitivity and specificity for C. trachomatis were 99% and 65%, respectively.…”

“…13 Of these 258 women, 96 (37.2%) had unexplained infertility. Altogether, 258 subfertile women were recruited for our previous study of C. trachomatis-induced humoral and cellmediated immunological markers in TFI diagnostics.…”

“…Altogether, 258 subfertile women were recruited for our previous study of C. trachomatis-induced humoral and cellmediated immunological markers in TFI diagnostics. 13 Of these 258 women, 96 (37.2%) had unexplained infertility. Those (n = 24) who conceived spontaneously before fertility workup was completed were also included in this group.…”