The limited clinical usefulness of taking a history in the evaluation of women with tubal factor infertility

Abstract

Objective To evaluate whether patient histories of gynecological infections predict tubal pathology seen at laparoscopic exam in infertile women. Design Cross-sectional analysis from a subset of case-control subjects. Setting Tertiary-level public hospitals with infertility clinics, Mexico City. Patient(s) Three hundred twenty-one nulligravid infertile women seeking diagnostic workup. Intervention(s) Interviews conducted before evaluation by laparoscopy. Main outcome measure(s) Sensitivity, specificity, and predictive values for correlating previous pelvic inflammatory disease symptoms, vaginal discharge, genital tract infections, and antibodies to Chlamydia trachomatis to confirmed diagnoses of tubal pathology and to severe tubal pathology. Result(s) Tubal pathology was found in 58% of participants (n = 185), and severe pathology was found in 29% (n = 92). None of the historical infection-related factors alone was a good overall predictor of tubal pathology; high sensitivity values (up to 73%) were offset by low specificity (down to 30%) and vice versa, for each factor. When considered simultaneously, the factors improved the overall predictive ability just slightly (84% sensitivity and 29% specificity) over the individual factors. The validity measures did not improve when examining severe tubal pathology alone. Conclusion(s) History taking related to past genital tract infections appears to be of little use in the evaluation of infertile women.