The Role of Chlamydia Trachomatis Infection in Female Infertility

Abstract

The incidence of positive Chlamydia cultures in females undergoing laparoscopy for tubal patency is high. We advocate routine screening for Chlamydia infection in females with infertility. Of seventy-five patients undergoing laparoscopy for infertility, 49 grew Chlamydia on tissue culture of material from the cervix, an incidence of 65.3%. Of these 49 cases, 33 (67.3%) had tubal blockage. In asymptomatic patients, 22 out of 50 had positive cultures from the cervix, an incidence of 44%. Peritoneal fluid culture was negative in all infertile patients. When compared to populations studied elsewhere, the incidence of Chlamydia appears to be high in our population and significantly higher in the infertile patients. In the management of infertility, pelvic inflammatory disease, and neonatal conjunctivitis, Chlamydia should be routinely investigated and treated. Infertility is increasing in many areas of the world, including Saudi Arabia, and poses a major health problem. Tubal occlusion produced by peritubal adhesions, hydrosalpinx formation, and intraluminal adhesions is the underlying pathological abnormality in tubal infertility following acute salpingitis [1]. The risk of infertility following Chlamydia infection is still unknown. Chlamydia trachomatis has been isolated from the fallopian tubes of females with acute pelvic inflammatory disease (PID) [2], Serological studies for Chlamydia have also established a link between infection with Chlamydia and adhesion formation. High serum titers of Chlamydial antibodies have been reported in infertile women with damaged fallopian tubes [3,4]. Between 64% and 91% of infertile females with tubal occlusion had antibodies to Chlamydia, a prevalence two to eight times greater than that found in females with other causes of infertility [5].Chlamydia trachomatis was also found in cultures from the endometrium of infertile females with antiChlamydial antibodies in 26% of cases and from the endocervix in 32% [6]. However, Chlamydia trachomatis was recovered from fallopian tube biopsies in 15% of females undergoing tubal surgery for infertility, and from the endometrium in 80% of them [7].The present study was carried out with the objective to determine the prevalence of Chlamydia trachomatis in the lower genital tract of asymptomatic Saudi patients attending King Khalid University Hospital (KKUH), the prevalence of Chlamydia trachomatis in the genital tract of infertile patients, and to determine the relationship between the organism and tubal infertility. The incidence of Chlamydia trachomatis in the peritoneal fluid of infertile patients was also determined, and the usefulness of analysis of the peritoneal fluid for culture of Chlamydia trachomatis evaluated. Patients and MethodsOver a ten month period between October 1989 and July 1990, 158 consecutive females undergoing evaluation for infertility at KKUH were approached to enroll in this study. All patients were married and all were Saudis. All females were enrolled at their initial visit to the clinic if they were involunta...