UNSUSPECTED CHLAMYDIA-TRACHOMATIS INFECTION AND IN-VITRO FERTILIZATION OUTCOME

OBJECTIVE: Chlamydia trachomatis infections of the female genital trac t, although a major cause of infertility, are often asymptomatic and u ndetected. Since many infertile women now seek in vitro fertilization, a procedure whereby fertilization and embryo implantation are precise ly timed, we sought to determine the relation between an unsuspected C . trachomatis infection and the ability of embryos to implant and deve lop after their transfer to the uterus. STUDY DESIGN: At the time of o ocyte aspiration, endocervical samples were obtained from 216 women an d assayed by enzyme-linked immunoassay for immunoglobulin A antibodies to C. trachomatis structural membrane components and to recombinant C . trachomatis heat shock protein. The presence of C. trachomatis in th e cervices was assessed by the polymerase chain reaction. The outcome of each in vitro fertilization cycle was then ascertained. RESULTS: Oo cytes from 198 (91.7%) of the women were fertilized in vitro and subse quently transferred to the uterus. Term deliveries of healthy infants occurred after 68 (34.3%) of these transfers. Cervical immunoglobulin A antibodies to chlamydial heat shock protein were detected in 5 (7.3% ) of the women with term births, and 1 (1.5%) also had immunoglobulin A antibody to chlamydial structural components; 3 (4.4%) were positive by the polymerase chain reaction for C. trachomatis. In contrast, amo ng the 130 women whose embryo transfers did not result in an ongoing p regnancy, 36 (27.7%) had cervical antiheat shock protein immunoglobuli n A (p = 0.0007) and 24 (18.5%) had antichlamydial structural componen t immunoglobulin A (p = 0.0002); 15 (11.5%) of these women had positiv e results of polymerase chain reaction for C. trachomatis. The majorit y of women with cervical antibodies to chlamydial structural antigens were also positive for antibody to heat shock protein. However, only 3 5% of the women with antibodies to heat shock protein were also positi ve for the other chlamydial antibodies. C. trachomatis was detected by polymerase chain reaction in 29.2% of women with anti-C. trachomatis antibodies and 7.8% of women with anti-heat; shock protein antibodies. Women positive for antichlamydial immunoglobulin A were more likely t o be undergoing a repeat in vitro fertilization cycle than were women who were antibody negative (p = 0.007). CONCLUSION: Unsuspected C. tra chomatis infection or reactivation of an immune response to the C. tra chomatis heat shock protein may induce an inflammatory reaction in the uterus that impairs embryo implantation and/or facilitates immune rej ection after uterine transfer of in vitro fertilized embryos.