Chlamydia trachomatis immunoglobulin G3 seropositivity is a predictor of reproductive outcomes in infertile women with patent fallopian tubes
Anne Z Steiner, Michael P Diamond, Richard S Legro, William D Schlaff, Kurt T Barnhart, Peter R Casson, Gregory M Christman, Ruben Alvero, Karl R Hansen, William M Geisler, Tracey Thomas, Nanette Santoro, Heping Zhang, Esther Eisenberg, Reproductive Medicine Network, C Bartlebaugh, W Dodson, S Estes, C Gnatuk, R Ladda, J Ober, R Brzyski, C Easton, A Hernandez, M Leija, D Pierce, R Robinson, J Ager, A Awonuga, L Cedo, A Cline, K Collins, S Krawetz, E Puscheck, M Singh, M Yoscovits, C Coutifaris, K Lecks, L Martino, R Marunich, A Comfort, M Crow, A Hohmann, S Mallette, Y Smith, J Randolph, S Fisseha, D Ohl, M Ringbloom, J Tang, W Bates, S Mason, L B Craig, C Zornes, M R Rodriguez, T S Hunt, N DiMaria, R Usadi, S Lucidi, M Rhea, V Baker, K Turner, M Brennan, D DelBasso, H Huang, Y Jin, Y Li, H Kuang, R Makuch, P Patrizio, L Sakai, L Scahill, C Song, H Taylor, T Thomas, S Tsang, Q Yan, M Zhang, D Haisenleder, J Trussell, B Laylor, L Martinez, A Solnica, A Wojtczuk, A Seungdamrong, M Rosen, C Lamar, L DePaolo, D Guzick, A Herring, J Bruce Redmond, M Thomas, P Turek, J Wactawski-Wende, R Rebar, P Cato, V Dukic, V Lewis, P Schlegel, F Witter, Anne Z Steiner, Michael P Diamond, Richard S Legro, William D Schlaff, Kurt T Barnhart, Peter R Casson, Gregory M Christman, Ruben Alvero, Karl R Hansen, William M Geisler, Tracey Thomas, Nanette Santoro, Heping Zhang, Esther Eisenberg, Reproductive Medicine Network, C Bartlebaugh, W Dodson, S Estes, C Gnatuk, R Ladda, J Ober, R Brzyski, C Easton, A Hernandez, M Leija, D Pierce, R Robinson, J Ager, A Awonuga, L Cedo, A Cline, K Collins, S Krawetz, E Puscheck, M Singh, M Yoscovits, C Coutifaris, K Lecks, L Martino, R Marunich, A Comfort, M Crow, A Hohmann, S Mallette, Y Smith, J Randolph, S Fisseha, D Ohl, M Ringbloom, J Tang, W Bates, S Mason, L B Craig, C Zornes, M R Rodriguez, T S Hunt, N DiMaria, R Usadi, S Lucidi, M Rhea, V Baker, K Turner, M Brennan, D DelBasso, H Huang, Y Jin, Y Li, H Kuang, R Makuch, P Patrizio, L Sakai, L Scahill, C Song, H Taylor, T Thomas, S Tsang, Q Yan, M Zhang, D Haisenleder, J Trussell, B Laylor, L Martinez, A Solnica, A Wojtczuk, A Seungdamrong, M Rosen, C Lamar, L DePaolo, D Guzick, A Herring, J Bruce Redmond, M Thomas, P Turek, J Wactawski-Wende, R Rebar, P Cato, V Dukic, V Lewis, P Schlegel, F Witter
Abstract
Objective: To determine if Chlamydia trachomatis (C. trachomatis) seropositivity, as detected by the C. trachomatis elementary body (EB)-based enzyme-linked immunosorbent assay [EB ELISA] predicts pregnancy and pregnancy outcome among infertile women with documented tubal patency.
Design: Cohort study.
Setting: Outpatient clinics.
Patient(s): In all, 1,250 infertile women with documented tubal patency enrolled in 1 of 2 randomized controlled trials: Pregnancy in Polycystic Ovary Syndrome II; and the Assessment of Multiple Intrauterine Gestations From Ovarian Stimulation.
Intervention(s): Sera were analyzed for anti-C. trachomatis immunoglobulin G (IgG)1 and IgG3 antibodies, using a research C. trachomatis EB ELISA. The optical density (OD)405 readings of ≥ 0.35 and ≥ 0.1 were considered positive for IgG1 and IgG3, respectively.
Main outcome measure(s): Primary outcomes included pregnancy, live birth, and ectopic pregnancy. Log-linear regression was used to determine the relative risk after adjusting for age, race, treatment medication, smoking status, and current alcohol use.
Result(s): A total of 243 (19%) women were seropositive for anti-C. trachomatis IgG3. They tended to be nonwhite and smokers. Anti-C. trachomatis IgG3 seropositive women were significantly less likely to conceive (risk ratio [RR] 0.65, 95% confidence interval [CI] 0.52-0.83) or to have a live birth (RR 0.59, 95% CI 0.43-0.80); these associations were weakened after adjusting for number of hysterosalpingography-documented patent tubes (RR 0.73, 95% CI 0.56-0.97) and (RR 0.73, 95% CI 0.50-1.04), respectively. Anti-C. trachomatis IgG3 seropositive women who conceived had a ×2.7 risk (95% CI 1.40-5.34) of ectopic pregnancy.
Conclusion(s): Even in the presence of tubal patency, anti-C. trachomatis IgG3 seropositivity is associated with a lower likelihood of pregnancy. Anti-C. trachomatis IgG3 seropositive women have as high as 3 times the risk of ectopic pregnancy.
Clinical trial registration number: PPCOSII: NCT00719186 and AMIGOS: NCT01044862.
Keywords: Chlamydia trachomatis; ectopic pregnancy; infertility; pregnancy.
Conflict of interest statement
Disclosures: Please see conflict of interest forms.
Copyright © 2015 American Society for Reproductive Medicine. All rights reserved.
Source: PubMed