Clinical findings and chlamydia antibody titre as predictors of tubal factor infertility

Abstract

Objective:To compare the predictive capacity of clinical scoring system and chlamydia antibody titre in predicting tubal disease.Methods:This study included 70 infertile women with normal ovarian and male factors. All women had detailed history taking, general examination, local examination, and vaginal and cervical swabs for culture and sensitivity. A clinical scoring system based on the following variables was used for prediction of tubal disease; age, infertility duration, previous abortion, previous delivery, dysmenorrhea, dyspareunia, evidence of bacterial vaginosis, and tender adnexa. IgG chlamydia antibody titre (CAT) and mid luteal phase serum progesterone were assessed using enzyme immunoassay (ELISA) technique. Tubal abnormality was assessed by hysterosalpingography (HSG) in the follicular phase. The clinical scoring and the CAT were compared by calculating the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio (+LR), negative likelihood ratio (-LR), the relative risk (RR), and the area under the curve (AUC) of the receiver operator curve.Results:CAT was positive in 20 patients (28.57%) out of the 70 studied women. Evidence of tubal disease identified by HSG was present in 34 patients (48.6%). Seropositive women had significantly higher incidence of tubal abnormality compared to seronegative women (p=0.0001). The CAT was significantly higher in women with tubal disease (11.63 ± 7.27) compared to women with normal tubes (6.76 ± 4.02) (z=3.126, p=0.002). The CAT achieved a low sensitivity of 50% and a high specificity of 91.67%. In comparison, the clinical scoring system achieved a balanced sensitivity and specificity of 82.35% and 86.11% respectively. The AUC of the clinical scoring system (0.891) was found to be significantly higher than that of the CAT (0.717).Conclusion:The clinical scoring system proved to be more accurate than the CAT in predicting tubal disease.