Impact of genital Chlamydia trachomatis infection on reproductive outcomes among infertile women undergoing tubal flushing: a retrospective cohort at a fertility centre in Uganda

Abstract

Background: The impact of current C. trachomatis on clinical pregnancy and live birth rates among women undergoing tubal flushing is largely unknown. This study aimed to investigate whether current female genital C. trachomatis infection affects the chance of achieving a clinical pregnancy and a live birth, among infertile women undergoing tubal flushing, at a fertility centre in Uganda. Methods: A retrospective Cohort study at a peri-urban fertility centre. A total of 253 eligible women with tubal factor infertility, who underwent tubal flushing, were enrolled and categorised according to their exposure to current genital C. trachomatis infection. These women were followed up for a period of 12 months, with the primary outcome measure being clinical pregnancy and live birth. Secondary outcome measures included pregnancy loss and procedural related adverse events. Results: Exposure to current genital C. trachomatis infection reduced chance of clinical pregnancy (adjusted relative risk 0.42; 95% confidence interval, 0.18-0.96) and a live birth (adjusted relative risk 0.37; 95% confidence interval, 0.14-0.95) after tubal flushing. Women with current C. trachomatis infection had an increased risk of adverse events (adjusted relative risk, 1.20; 95% confidence interval, 1.08-1.34). However, current C. trachomatis infection did not affect the risk of spontaneous abortion and ectopic pregnancy. Conclusion: Current genital C. trachomatis infection in women with tubal factor infertility, undergoing tubal flushing, lowers their chance of pregnancy and live birth.

The Correlation between Chlamydia Trachomatis and Female Infertility: A Systematic Review

“…Davies et al, 12 Ramadhani et al, 14 and Kayiira et al, 19 by presenting results that strengthen the discussed association, claim that policies of routine screening and interventions focused on preventing both first and repeated infections are extremely important in order to improve women's long-term reproductive health. 12,14,19 The type of female infertility more commonly associated with CT infection is tubal factor infertility (TFI), which occurs due to tubal occlusion (Toye et al, 1993). 27 According to Hoenderboom et al, 22 CT positivity represents a fourfold higher risk for TFI.…”

“…This is also expressed in den Heijer et al 23 finding that CT-positive women had approximately 70% higher chance of experiencing infertility. Davies et al, 12 Ramadhani et al, 14 and Kayiira et al, 19 by presenting results that strengthen the discussed association, claim that policies of routine screening and interventions focused on preventing both first and repeated infections are extremely important in order to improve women's long-term reproductive health. 12 14 19 …”

Prevalence of Endocervical Chlamydia trachomatis Infection and Related Risk Factors Among Women Attending Gynecology Clinic of Birjand University of Medical Sciences, East of Iran

“…This finding is comparable to those reported by others and suggests that a history of vaginal infection may be the major risk factor for chlamydial infection. Kayiira et al showed that over 36.96% of the participants with current genital C. trachomatis had a history of genital infection compared to 2.9% of participants in the non-exposed group (21). Nevertheless, the fact that the sample size did not achieve statistical power can explain the lack of association between C.…”

Chlamydia: The Female Reproductive System and Infertility

“…den Heijer et al also found that CT-positive women were 70% more likely to experience infertility [112]. Davies [113], Ramadhani [114], and Kayiira [115] also showed results that reinforce this relationship in different countries and populations, noting that routine chlamydia screening, along with interventions to prevent initial and recurrent infections, is extremely important to protect women's long-term reproductive health.…”