The accuracy of serum chlamydial antibodies in the diagnosis of tubal pathology: a meta-analysis

Abstract

Objective: To assess the discriminative capacity of Chlamydia antibody titers in the diagnosis of tubal pathology in subfertile patients. Design: Meta-analysis of studies comparing Chlamydia antibody titers and laparoscopy for tubal patency and peritubal adhesions. Patients: A total of 2,729 patients with subfertility in 23 studies. Intervention(s): Chlamydia antibody titer and laparoscopy as part of subfertility work-up. Main Outcome Measure: Sensitivity and specificity of Chlamydia antibody titers in the diagnosis of tubal pathology using laparoscopy with chromopertubation as the reference standard. Result(s): The discriminative capacity of Chlamydia antibody titers depended on the type of assay that was used. Summary receiver operating characteristic (ROC) curves of studies using ELISA or (micro)immunofluorescence revealed a better discrimination than the summary ROC-curve of studies using immunoperoxidase assay. Conclusion(s): The discriminative capacity of Chlamydia antibody titers by means of ELISA, microimmunofluorescence, or immunofluorescence in the diagnosis of any tubal pathology is comparable to that of hysterosalpingography (HSG) in the diagnosis of tubal occlusion. Chlamydia antibody testing involves little burden but provides no details on the anatomy of uterus and tubes. Whether or not Chlamydia antibody testing can replace HSG depends on the perspective taken in the diagnostic work-up of subfertility.