Chlamydia trachomatis immunoglobulin G3 seropositivity is a predictor of reproductive outcomes in infertile women with patent fallopian tubes

doi:10.1016/j.fertnstert.2015.08.022

Fertility and Sterility

Volume 104, Issue 6, December 2015, Pages 1522-1526

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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.

Key Words

Chlamydia trachomatis

infertility

pregnancy

ectopic pregnancy

Cited by (0)

: A.Z.S. has nothing to disclose. M.P.D. has nothing to disclose. R.S.L. reports a grant from Ferring; and personal fees from Ferring, Astra Zeneca, Euroscreen, Clarus Therapeutics, and Takeda. W.D.S. reports research support grants from AbbVie Pharmaceuticals. K.T.B. has nothing to disclose. P.R.C. has nothing to disclose. G.M.C. is on the advisory board of Bayer Pharmaceuticals; received grants from Bayer Pharmaceuticals and Abbvie Pharmaceuticals; received honoraria from Abbvie Pharmaceuticals. R.A. has nothing to disclose. K.R.H. subcontracted with Yale University/ Reproductive Medicine Network/NICHD for salary support and patient care costs; and has received grants from Ferring International Pharmascience Center US and Roche Diagnostics. W.M.G. was contracted by Yale University (a research center of the Reproductive Medicine Network) to perform the chlamydia serology for the study; contract funds were research funds that went to University of Alabama. T.T. reports an Reproductive Medicine Network grant from NICHD. N.S. has nothing to disclose. H.Z. reports an NIH grant. E.E. has nothing to disclose.

: W.D.S.’s current affiliation: Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.

: P.R.C.’s current affiliation: Northeastern Reproductive Medicine, Colchester Vermont.

: G.M.C.’s current affiliation: Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida.

: In addition to the authors, other members of the NICHD Reproductive Medicine Network were as follows: Penn State College of Medicine, Hershey: C. Bartlebaugh, W. Dodson, S. Estes, C. Gnatuk, R Ladda, J. Ober; University of Texas Health Science Center at San Antonio: R. Brzyski, C. Easton, A. Hernandez, M. Leija, D. Pierce, R. Robinson; Wayne State University: J. Ager, A. Awonuga, L. Cedo, A. Cline, K. Collins, S. Krawetz, E. Puscheck, M. Singh, M. Yoscovits; University of Pennsylvania: C. Coutifaris (PI for Penn), K. Lecks, L. Martino, R. Marunich; P. Snyder University of Colorado: A. Comfort, M. Crow; University of Vermont: A. Hohmann, S. Mallette; University of Michigan: Y. Smith, J. Randolph, S. Fisseha, D. Ohl, M. Ringbloom, J. Tang; University of Alabama Birmingham: W. Bates, S. Mason; University of Oklahoma Health Sciences Center: L.B. Craig, C. Zornes, M.R. Rodriguez, T.S. Hunt; Carolinas Medical Center: N. DiMaria, R. Usadi; Virginia Commonwealth University: S. Lucidi, M. Rhea; Stanford University Medical Center: V. Baker, K. Turner; Yale University: 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; Ligand Core Laboratory, University of Virginia Center for Research in Reproduction: D. Haisenleder; Upstate University Hospital: J. Trussell; University of Medicine and Dentistry of New Jersey: B. Laylor, L. Martinez, A. Solnica, A. Wojtczuk, A. Seungdamrong; University of California, San Francisco: M. Rosen; Eunice Kennedy Shriver National Institute of Child Health and Human Development: C. Lamar, L. DePaolo; Advisory Board: D. Guzick (Chair), A. Herring, J. Bruce Redmond, M. Thomas, P. Turek, J. Wactawski-Wende; Data and Safety Monitoring Committee: R. Rebar (Chair), P. Cato, V. Dukic, V. Lewis, P. Schlegel, and F. Witter.

: This work was supported by National Institutes of Health (NIH)/Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) grants U10HD077844 (to A.Z.S.), U10 HD39005 (to M.P.D.), U10 HD38992 (to R.S.L.), U10 HD27049 (to K.T.B.), U10 HD38998 (to R.A. and W.D.S), U10 HD055942, HD055944 (to P.R.C.), U10 HD055936 (to G.M.C.), U10HD055925 (to H.Z.); U10 U54- HD29834 (to the University of Virginia Center for Research in Reproduction Ligand Assay and Analysis Core of the Specialized Cooperative Centers Program in Reproduction and Infertility Research); and an NIH grant UL1 TR000127 (to Pennsylvania State University).