CHLAMYDIAL SEROLOGY IN 1303 ASYMPTOMATIC SUBFERTILE COUPLES

The clinical significance of antichlamydial antibodies (Chlam Ab) was determined in a total of 1303 subfertile couples consulting for infert ility investigation and treatment. Median age of the women was 30 (ran ge 22-44) years and of the men 33 (range 21-53) years. The median dura tion of infertility was 4 (range 1-21) years. All patients were asympt omatic for genital tract infection. A comprehensive infertility invest igation included examination of the endocrine, cervical, and tubal fac tor, and semen analysis, antisperm antibody (ASA) testing, sperm-mucus interaction testing in vitro a standardized protocol, and post-coital testing (PCT). Screening for Chlam IgG Ab was performed in serum of b oth partners, obtained at the same time. Simultaneous microbial cultur es in genital secretions of both partners included a broad spectrum of potentially pathogenic bacteria. Elevated titres of Chlam IgG Ab as s eromarker for previous infection were found in 20.8% of all women, and in 12.6% of men. Chlam Ab were significantly more frequent in partner s of seropositive patients (in 51.8% of women with a Chlam Ab positive partner, compared to 15.8% of the other women). Microbial screening o utcome was not significantly related to results of chlamydial serology in both partners. In women, elevated titres of Chlam Ab were signific antly associated with a tubal factor, but were not related to reduced quality of the endocervical mucus (CM), including the in-vitro penetra bility of the CM (using partners' or donors' spermatozoa). In males, C hlam Ab were not significantly related to the outcome of semen analysi s, including screening for ASA (IgG and/or IgA) in semen, and several parameters of sperm functional capacity. After exclusion of couples wi th tubal disease, subsequent male fertility did not significantly diff er in males with or without Chlam Ab. The results suggest that during basic infertility investigation, positive chlamydial serology as an ea sy screening procedure indicates a higher risk for a tubal infertility factor. However, in asymptomatic patients, Chlam IgG Ab in serum are not associated with a cervical factor or with the male factor, using s everal determinants for evaluation of semen quality including subseque nt fertilizing capacity.