HUMORAL IMMUNE-RESPONSE TO MEMBRANE-COMPONENTS OF CHLAMYDIA-TRACHOMATIS AND EXPRESSION OF HUMAN 60 KDA HEAT-SHOCK-PROTEIN IN FOLLICULAR-FLUID OF IN-VITRO FERTILIZATION PATIENTS

Recent evidence suggests that Chlamydia trachomatis can persist in the female upper genital tract in an unculturable state. Since unsuspecte d C.trachomatis infection has been associated with adverse in-vitro fe rtilization (IVF) outcome we sought to detect further evidence of C.tr achomatis in the genital tracts of women undergoing IVF, The prevalenc e and distribution of antibodies to the major structural proteins of C .trachomatis in paired follicdar fluid and sera of women undergoing IV F were examined. Sera and follicular fluid samples from 149 women were assayed for immunoglobulin (Ig)G and IgA antibodies to two C.trachoma tis antigens, the major outer membrane protein (MOMP) and a recombinan t lipopolysaccharide (rLPS) fragment, Additionally, the expression of human 60 kDa heat shock protein (hsp 60) in follicular fluid was deter mined, All cervical and follicular fluid samples were negative for C.t rachomatis by polymerase chain reaction, ligase chain reaction and DNA probe. Sera from 60% of the subjects were positive for antichlamydial rLPS IgG; 36% were positive for anti-MOMP IgG, Similarly, rLPS-direct ed and MOMP-directed IgA were detected in sera of 34 and 14% of the su bjects respectively. IgG antibodies to MOMP and rLPS were detected in 42 and 41% of the follicular fluid examined respectively. Anti-MOMP Ig A was identified in 8.7% of the follicular fluid while 27.5% were posi tive for anti-rLPS IgA. Human hsp 60 expression,vas documented in 11.6 % of the follicular fluid tested. IgA antibodies to both MOMP (P = 0.0 3) and rLPS (P = 0.02) in follicular fluid mere associated with a fail ure to become pregnant after embryo transfer. IgG antibodies in sera a nd follicular fluid and IgA antibodies in sera were unrelated to IVF o utcome. Similarly only anti-MOMP IgA (P = 0.02) and anti-rLPS IgA (P = 0.04) in follicular fluid were correlated with human hsp 60 expressio n in follicular fluid. The unique association between IgA antibodies t o two chlamydial antigens in follicular fluid and both hsp 60 expressi on and IVF failure provides further support for the possibility that a persistent upper genital tract chlamydial infection contributes to IV F failure in some women.