THE ACCURACY OF SERUM CHLAMYDIAL ANTIBODIES IN THE DIAGNOSIS OF TUBALPATHOLOGY - A METAANALYSIS

Objective: To assess the discriminative capacity of Chlamydia antibody titers in the diagnosis of tubal pathology in subfertile patients. De sign: Meta-analysis of studies comparing Chlamydia antibody titers and laparoscopy for tubal patency and peritubal adhesions. Patients: A to tal of 2,729 patients with subfertility in 23 studies. Intervention(s) : Chlamydia antibody titer and laparoscopy as part of subfertility wor k-up. Main Outcome Measure: Sensitivity and specificity of Chlamydia a ntibody titers in the diagnosis-of tubal pathology using laparoscopy w ith chromopertubation as the reference standard. Result(s): The discri minative 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 immu noperoxidase assay. Conclusion(s): The discriminative capacity of Chla mydia antibody titers by means of ELISA, microimmunofluorescence, or i mmunofluorescence in the diagnosis of any tubal pathology is comparabl e to that of hysterosalpingography (HSG) in the diagnosis of tubal occ lusion. Chlamydia antibody testing involves little burden but provides no details on the anatomy of uterus and tubes. Whether or not Chlamyd ia antibody testing can replace HSG depends on the perspective taken i n the diagnostic work-up of subfertility. (C) 1997 by American Society for Reproductive Medicine.