Keltz Martin D, Sauerbrun-Cutler May-Tal, Durante Margaret S, Moshier Erin, Stein Daniel E, Gonzales Eric
From the *Continuum Reproductive Center, St Lukes-Roosevelt Hospital Center, and College of Physicians, Columbia University, New York, NY; †NYU Langone Medical Center, New York, NY; and ‡Department of Community and Preventive Medicine, Icahn School of Medicine at Mt Sinai, New York, NY.
Sex Transm Dis. 2013 Nov;40(11):842-5. doi: 10.1097/OLQ.0000000000000035.
There are no prior studies that assess the non-in vitro fertilization (IVF) pregnancy rates in chlamydia serology-positive versus serology-negative women. Therefore, we wanted to determine whether a positive Chlamydia trachomatis immunoglobulin G serology result predicts reduced clinical pregnancy rates without IVF.
A prospective observational study was performed at a university-affiliated reproductive center. A total of 1279 new infertility patients seen at the Continuum Reproductive Center between January 2007 and June 2009 underwent C. trachomatis immunoglobulin G screening. Charts were later reviewed for hysterosalpingography, laparoscopy, treatment cycles, and ultrasound evidence of an intrauterine pregnancy. The main outcome measure was non-IVF cumulative pregnancy rates.
Seventy (5.5%) of 1279 of the participants were found to have a positive chlamydia serology result. Serology-positive participants had significantly more tubal block on hysterosalpingography (37.5% vs. 10.1%, P = 0.001) and laparoscopically confirmed tubal damage (85.7% vs. 48.9%, P = 0.002). The percent of all participants who achieved an ultrasound documented clinical pregnancy, at our center, without IVF was significantly lower among Chlamydia-positive participants (10.0% versus 21.7%) in seronegative participants (P < 0.02). The hazard rate of non-IVF clinical pregnancy among chlamydia antibody testing-positive patients was 57% less than the rate of pregnancy among chlamydia antibody testing-negative patients (hazard ratio, 0.43; 95% confidence interval, 0.20-0.92). Both the per-cycle and the cumulative IVF pregnancy rates were equivalent in seropositive and in seronegative participants.
This is the first large study to report that a positive serology screening result is both predictive of tubal damage and a reduced cumulative pregnancy rate when excluding treatment with IVF.
此前尚无研究评估衣原体血清学阳性与血清学阴性女性的非体外受精（IVF）妊娠率。因此，我们想确定沙眼衣原体免疫球蛋白G血清学结果呈阳性是否预示着未经IVF的临床妊娠率降低。
在一所大学附属生殖中心进行了一项前瞻性观察研究。2007年1月至2009年6月期间，连续生殖中心共1279例新的不孕患者接受了沙眼衣原体免疫球蛋白G筛查。随后查阅病历，了解子宫输卵管造影、腹腔镜检查、治疗周期以及宫内妊娠的超声证据。主要结局指标为非IVF累积妊娠率。
1279名参与者中有70名（5.5%）衣原体血清学结果呈阳性。血清学阳性的参与者子宫输卵管造影显示输卵管阻塞的比例显著更高（37.5%对10.1%，P = 0.001），腹腔镜检查证实的输卵管损伤比例也更高（85.7%对48.9%，P = 0.002）。在我们中心，衣原体阳性参与者中通过超声记录的未经IVF的临床妊娠率显著低于衣原体阴性参与者（10.0%对21.7%）（P < 0.02）。衣原体抗体检测阳性患者的非IVF临床妊娠风险率比衣原体抗体检测阴性患者的妊娠率低57%（风险比，0.43；95%置信区间，0.20 - 0.92）。血清阳性和血清阴性参与者的每个周期IVF妊娠率和累积IVF妊娠率相当。
这是第一项大型研究，报告血清学筛查结果呈阳性既预示着输卵管损伤，又预示着排除IVF治疗时累积妊娠率降低。
