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Positive Chlamydia trachomatis Serology Result in Women Seeking Care for Infertility Is a Negative Prognosticator for Intrauterine Pregnancy

Keltz, Martin D. MD*; Sauerbrun-Cutler, May-Tal MD*; Durante, Margaret S. MD; Moshier, Erin MS; Stein, Daniel E. MD*; Gonzales, Eric MS*

doi: 10.1097/OLQ.0000000000000035
Original Study

Background 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.

Methods 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.

Results 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.

Conclusions 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.

This is the first study to report that infertile patients with a positive chlamydia serology result are less likely than seronegative patients to conceive without in vitro fertilization.

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

Conflict of interest: None declared.

Oral presentation at the ASRM annual meeting in 2010 in Denver, Colorado.

Correspondence: May-Tal Sauerbrun-Cutler, MD, Continuum Reproductive Center, St Lukes–Roosevelt Hospital Center, 425 West 59th st Ste. 5A, New York, NY 10019. E-mail:

Received for publication April 24, 2013, and accepted August 19, 2013.

© Copyright 2013 American Sexually Transmitted Diseases Association