Abstract

Background: The objective of this study was to determine the prevalence of Chlamydia trachomatis among both men and women seeking assistance at an infertility dispensary, and to prospectively follow the issue of previous infection on pregnancy rates and pregnancy outcome later on a long follow‐up period (mean 37 months). METHODS: A full of 244 infertile couples was tested for C. trachomatis IgG antibodies, and IgG+ couples were also tested for C. trachomatis DNA by PCR in a first‐void urine sample. Report parameters were serology, PCR results, clinical diagnoses, treatments, pregnancy rates and pregnancy outcome. Equally controls, historic period‐matched and spontaneously pregnant women were likewise tested with serology. RESULTS: The prevalence of IgG antibodies was 24.two, xx.1 and fifteen.six% among infertile women, infertile men and control women respectively. The prevalence of C. trachomatis Deoxyribonucleic acid was 6.8 and 7.i% amidst tested women and men respectively. The presence of C. trachomatis IgG antibodies in women was related to tubal cistron infertility (TFI) (P = 0.002). Decreased pregnancy rates were seen in couples where the human being was IgG+ (P = 0.005) with no relationship to TFI. Among women who achieved pregnancy, in that location was no difference in pregnancy upshot betwixt IgG+ or negative couples. CONCLUSIONS: C. trachomatis IgG antibodies in the man of the infertile couple was related to decreased pregnancy rates and to the presence of IgG antibodies in the woman. There was a high prevalence of asymptomatic persistent infections among infertile couples.

Introduction

Chlamydia trachomatis is ane of the well-nigh prevalent sexually transmitted diseases (STD) worldwide. In Sweden the incidence charge per unit has increased from 157 to 189 per 100 000 from 1997 to 1999 ( Gotz et al., 2002), and even farther during recent years (Ekdahl, 2002). An infection with C. trachomatis is known to be difficult to diagnose and tin can persist in the genital tract for a long period of time (Witkin, 2002). Persistence of genital chlamydia infections has recently been demonstrated in 87% of untreated men and women ( Joyner et al., 2002). The finding of C. trachomatis IgG antibodies, as a marker of previous or persistent infection, shows a loftier prevalence in women with tubal factor infertility (TFI) ( Mol et al., 1997). TFI is suggested to reduce pregnancy rates after IVF ( Strandell et al., 2000) and the clinical demonstration of a Fallopian tube persistently dilated by fluid (hydrosalpinx) is in itself a negative predictor for pregnancy ( Strandell et al., 1994), but details of the suggested machinery(due south) are as yet unknown. A recent meta‐assay concluded that laparoscopic salpingectomy prior to IVF treatment increases the odds of pregnancy and live birth as compared with no salpingectomy in the short term ( Johnson et al., 2002).

When it comes to the relevance of testing for C. trachomatis in infertility investigation of the male person partner, opinions diverge. Whether C. trachomatis exerts a direct upshot on sperm quality or whether the male accompaniment glands are merely reservoirs for C. trachomatis bacteria that are repeatedly transmitted to the female person partner, thereby causing for example tubal damage and diminished pregnancy chances, or a combination of both, remains unknown. There is, to our knowledge, simply 1 previous study that has investigated the relationship betwixt male partner C. trachomatis IgG antibodies and subsequent pregnancy rates. That study reported a lower pregnancy rate afterward a 6 calendar month follow‐up catamenia, among couples where the man was positive for C. trachomatis IgG ( Eggert‐Kruse et al., 1990).

The nowadays study was undertaken to make up one's mind the prevalence of C. trachomatis antibodies and ongoing infections in couples attending the gynaecological outpatient clinic because of infertility. An boosted aim was to correlate the presence of C. trachomatis antibodies in the male person and female person partner to pregnancy rates and pregnancy outcome, whether accomplished spontaneously or later on assisted reproduction techniques. For controls, historic period‐matched women attention the maternity screening programme and reporting spontaneous pregnancies were tested for the prevalence of IgG‐antibodies to C. trachomatis.

Materials and methods

This study was a prospective cohort study and the Human Ethics Committee of the Medical Faculty, Umeå University, approved of all parts.

Patients and specimen sampling

During the menstruation October 1997 through Feb 2001 all consecutive couples (n = 244) attention the gynaecological outpatient clinic at Umeå University Hospital due to infertility (unfulfilled want for pregnancy for >1 year) were included in the written report. Claret was fatigued from both partners upon their first visit, and tested for the occurrence of IgG antibodies to C. trachomatis after informed consent. Both partners were tested for HIV and hepatitis B and C. The female was tested for rubella immunity, and for ovulation by using mid‐luteal serum progesterone. Semen analysis (using criteria according to the World Health Organization as modified by NAFA/ESHRE; Kvist and Björndahl, 2002) of the human was undertaken. The couple received general information about the investigation to come. If ane of the partners of the couple had C. trachomatis IgG antibodies (threshold level 1/20), a second blood examination for confirmation of the result was drawn and a start‐void urine sample for detection of C. trachomatis DNA was collected. If at least one of the partners was positive in the DNA test for C. trachomatis, they were both treated with doxycycline 100 mg ×2 the starting time day and thereafter doxycycline 100 mg ×one for ix more days. None of the partners who had a positive Deoxyribonucleic acid exam admitted to extramarital sex.

Chlamydia trachomatis serology and DNA testing

C. trachomatis‐specific IgG antibodies were determined by the microimmunofluorescence (MIF) exam (MRL Diagnostics/Focus, USA). Serum dilutions starting at 1/40 up to 1/640 were used. A weak specific immunofluorescence in the i/twoscore dilution was reported equally positive in 1/20. Antibiotic incubations were performed at 37°C for lx min. Positive and negative controls from the kit were included. Upon receipt, the urine specimens were analysed for C. trachomatis Deoxyribonucleic acid by means of a commercially available PCR test (Cobas Amplicor C. trachomatis test; Roche Diagnostics, Switzerland) according to the instructions from the manufacturer. For each specimen an internal control was included. A negative test issue was reported every bit negative only if the sample was negative for C. trachomatis and the internal control was positive. A sample positive for C. trachomatis was re‐analysed and reported equally positive if the re‐analysis was also positive.

Clinical investigation

Within 1–3 months later on their outset visit, when all test results were available, the couple returned to the clinic for a further consultation. This visit was conducted according to routine infertility work‐up including clinical test and ultrasonography, and further investigations such as hysterosalpingosonography (HSS) (north = 87), laparoscopy (north = 66), or both (n = 20) and boosted hormonal assays were planned. From here on the couples were advised about treatment according to the findings. TFI was divers as one or both tubes occluded or dilated at HSS or laparoscopic chromopertubation.

Follow‐upward

Afterward a follow‐up period of 14–54 months (hateful 37 months), the medical records of all couples included were studied with respect to C. trachomatis IgG antibodies and C. trachomatis Dna, findings at HSS and laparoscopy, clinical diagnoses, treatments and reported pregnancies. Primary endpoints of the study were pregnancy and pregnancy outcome (passed 28 weeks of gestation, spontaneous ballgame or ectopic pregnancy). All pregnancies were routinely screened by ultrasound at gestation week 15–17. Those couples who had non achieved pregnancy past the fourth dimension the medical records were studied were contacted by mail with information nigh the written report and a asking to contact them past telephone. During a structured telephone interview (carried out by A.I.) they were asked about whatsoever treatments not institute in the medical records (some couples were treated elsewhere) and pregnancies and pregnancy outcome that had not previously been recorded. Vi couples (2.five%) were lost to follow‐upwardly, of whom three couples had emigrated and the remaining iii did non reply or were unreachable. Thus, pregnancy data were bachelor from 238/244 (97.five%) of the couples.

Fertile controls

Retrospectively, serum was analysed from women attention the Antenatal Care programme at the local health care centres caring for women in the same region as the women attending the gynaecological outpatient clinic. At their beginning visit, claret had been collected for analysis of rubella immunity and an additional aliquot of serum was banked. Using the database from the computerized medical records, samples from these women were matched to the women seeking aid for infertility with respect to historic period (nascency yr) and the year when claret samples were collected. Only women with spontaneous pregnancies (every bit recorded in the medical records) were included (n = 244). Serum was analysed with respect to the presence of IgG antibodies to C. trachomatis by the same method as for the study population.

Statistics

The statistical analyses were performed using SPSS software version 10.0.7. For significance of deviation betwixt two independent groups, the χ2‐test, and, in applicative cases, Fisher'southward exact test, were used. P < 0.05 was considered significant. Spearman's not‐parametric rank correlation was used for calculating correlations. Odds ratios (OR) and conviction intervals (95% CI) were calculated past multiple logistic regression and multivariate analysis was performed. To minimize the chance of getting a Type 1 fault when making multiple comparisons, a Bonferroni–Holm adjustment of P‐values was done.

Results

Patients

Hateful age of the women was 31.ane ± 4.7 (mean ± SD) years and of the men 34.0 ± 5.4 years. Elapsing of infertility was ≥1 year but in isolated cases ranging up to 10 years. For the female partner the infertility was primary in 138/244 (56.half-dozen%) of the women and secondary in 106/244 (43.4%). In those women where the infertility was secondary, the woman had either had a kid or had a history of spontaneous ballgame, extrauterine  pregnancy or induced abortion.

Clinical diagnoses, Chlamydia trachomatis IgG and DNA prevalence

For distribution of the principal diagnoses, see Table I. Nineteen per cent of the women had TFI equally 1 of iii diagnoses. In the subgroup that underwent IVF/ICSI treatment, the proportion that had TFI as one of iii diagnoses was 22/57 (39%). For details of C. trachomatis IgG prevalence and DNA positivity, run across Table II. None of the patients complained of symptoms indicating ongoing STD. In the control group of pregnant women the prevalence of C. trachomatis IgG antibodies was 38/244 (15.vi%), which was significantly different from the prevalence in the group of infertile women (OR one.73, 95% CI 1.x–2.72, P = 0.023). The finding of a positive C. trachomatis Deoxyribonucleic acid amplification test using PCR was equally distributed in both sexes and in merely ane couple were both partners positive (Table Ii). All 9 couples where either one or both partner(southward) were positive in the C. trachomatis PCR test were treated with antibiotics. One calendar month after treatment, all couples were PCR‐tested again with a negative test effect. Four out of these 9 couples had TFI as the chief cause of infertility. During the follow‐up period, three of nine treated couples achieved pregnancies, all spontaneously.

Chlamydia trachomatis IgG and DNA amid women and human relationship to TFI and pregnancy rates

The finding of C. trachomatis IgG in the women was significantly related to the finding of TFI (Table Three). The presence of C. trachomatis IgG antibodies in the adult female among all couples tested (independent of diagnosis) was non related to pregnancy (Table Three). In the small group of IVF‐treated couples, the relationship between the woman's C. trachomatis IgG and pregnancy did not achieve statistical significance (northward = 32, OR 4.2, 95% CI 0.9–19.4, P = 0.13). In the C. trachomatis IgG– grouping, xv/20 were able to establish a pregnancy every bit compared with simply v/12 in the C. trachomatis IgG+ group. There was a significant, admitting weak, correlation between the level of the women's C. trachomatis IgG titres and the finding of a positive PCR test (r = 0.3, P = 0.026).

Chlamydia trachomatis IgG and DNA amid men and relationship to pregnancy rates

The finding of C. trachomatis IgG in the male person partners was a highly significant outcome predictor with an OR of 2.six (95% CI i.3–4.ix, P = 0.005) (Table III) of non achieving pregnancy. In the subgroup of couples that did not go through IVF or ICSI treatment, the OR of not achieving pregnancy if the homo was C. trachomatis IgG+ was even higher (OR 3.9, 95% CI 1.4–10.9, P = 0.012). Nevertheless, there was no meaning relationship between C. trachomatis IgG antibodies in the man and male factor infertility, the latter equally judged by sperm assay. There was no relationship between C. trachomatis IgG antibodies in the man and TFI in the female partner. No other pregnant relationships between male IgG positivity and possible confounding variables were seen (i.e. endometriosis, partner's age, treatments etc.). In the IVF or icsi grouping the C. trachomatis IgG– men achieved pregnancy in 28/43 (65.i%) of the cases equally compared with 6/fourteen (42.9%) amongst C. trachomatis IgG+ men. There was a highly pregnant relationship between C. trachomatis IgG‐positivity in the human and the woman (Tabular array 3) and as well a significant correlation betwixt their respective IgG titre levels (r = 0.4, P < 0.001).

Pregnancy outcome

For women who achieved pregnancy during the study period, whether spontaneous or treatment‐related, there were no statistically significant differences between C. trachomatis IgG+ or negative men and/or women apropos pregnancy result (Table IV). Furthermore, there were no differences in pregnancy outcome following dissimilar assisted reproduction treatments provided to C. trachomatis IgG+ or negative couples (information non shown). Although the diagnosis of a male person cistron seemingly was related to a higher incidence of spontaneous abortions (P = 0.025), this was found to be not significant when Bonferroni–Holm correction was applied.

Multivariate analysis

In a multivariate analysis, only one parameter was found to significantly influence the main study outcome. The finding of C. trachomatis IgG antibodies in the male person partner was related to a decreased likelihood of achieving pregnancy (Table III).

Discussion

As predictable, we found a raised prevalence of C. trachomatis IgG antibodies in the infertile population as compared with a proven fertile population. The presence of C. trachomatis IgG antibodies in the male partner of the infertile couple was significantly and inversely correlated to the overall pregnancy rate, with an OR of two.6 of not achieving pregnancy. An interesting finding in this study is that while a decreased pregnancy rate was seen in IgG+ couples, in that location were no differences in pregnancy outcome between IgG+ and IgG– couples. At that place was also a loftier prevalence of PCR‐detected C. trachomatis infections among couples exhibiting C. trachomatis IgG antibodies (13.i% of IgG+ couples or iii.seven% of the entire study group). Arguably, it should be cost‐benign to screen infertile C. trachomatis IgG+ patients using PCR to detect and treat a possible persistent infection, since this has been suggested to be cost‐constructive in populations with a prevalence of C. trachomatis of ≥four% ( Paavonen et al., 1998).

The strength of this written report was the relatively long follow‐upward period (mean 37 months) with few patients lost to follow‐upwards (2.5%). Still, the cohort was too small to make any firm conclusions as to the possible impact of circulating antibodies to C. trachomatis in some of the report subgroups. DNA testing was but performed if ane of the partners exhibited C. trachomatis IgG antibodies. Hence it is non possible to comprehensively evaluate the predictive value of a positive C. trachomatis IgG test and the gamble of detecting an ongoing C. trachomatis infection. Yet, the C. trachomatis IgG titre levels were significantly correlated to DNA findings, suggesting that in that location were very few—if whatever—DNA+ cases among those that were C. trachomatis IgG–.

Punnonen et al. (1979) clearly demonstrated an association between C. trachomatis seropositivity and TFI ( Mol et al., 1997). Similar to that finding, in the present study we found an OR of 3.6 of demonstrating tubal occlusion in a subsequent HSS or laparoscopy following a positive C. trachomatis IgG test of the female partner. There are diverging results from published studies, whether or not C. trachomatis IgG antibodies are a negative predictor for IVF issue. Several studies have demonstrated a negative relationship ( Rowland et al., 1985; Lunenfeld et al., 1989; Sharara and Queenan, 1999), while a few (smaller) studies did non notice such a relationship ( Torode et al., 1987; Tasdemir et al., 1994). In ane written report, doxycycline treatment may have masked the negative effect of C. trachomatis antibodies ( Sharara et al., 1997). Such antibody treatment may cure a hidden residual infection since a correlation between C. trachomatis antibodies and findings of antigen in ovarian, tubal and endometrial samples ( Czerwenka et al., 1994) has been demonstrated. However, C. trachomatis antigen has been identified in Fallopian tubes, ovaries and endometrium of culture‐negative women with tubal gene infertility ( Toth et al., 2000) and ectopic pregnancies ( Barlow et al., 2001). Yet, mechanisms other than residual C. trachomatis infections may reduce the pregnancy charge per unit in spontaneous or assisted reproductive cycles. Repeated or persistent C. trachomatis infections are suggested to elicit an autoimmune response to human heat stupor proteins (HSP) due to the structural similarities to chlamydial HSP ( Neuer et al., 1997; Witkin et al., 1998). This may in plough exert a negative influence on embryo development and implantation at vital stages when human being HSP are expressed, resulting in decreased reproductive event (Witkin, 1999; Neuer et al., 2000).

The present study draws attention to the interesting finding that male chlamydia IgG positivity confers a decreased fecundity in affected couples. Although as yet speculative, since they were not included as parameters in the present written report, decreased sperm motility or concurrent or undetected infection may play a part. It is known that infection with Mycoplasma genitalium, which is also sexually transmitted, is an established crusade of astute and probably also persistent not‐gonococcal urethritis (NGU) (Taylor‐Robinson, 2002). Employ of serological tests in women attention an infertility clinic has suggested that M. genitalium may be an independent gamble factor in the development of tubal damage ( Clausen et al., 2001). The nowadays study was not aimed to evaluate a possible effect of C. trachomatis IgG on semen characteristics of the male partner. Even so, no significant relationship betwixt C. trachomatis IgG seropositivity and the diagnosis on conventional spermiogram parameters indicative of male factor infertility, was establish. In one study comprising 491 asymptomatic males of infertile couples ( Eggert‐Kruse et al., 1990) a negative influence of male person C. trachomatis IgG antibodies on pregnancy rates afterward 6 months was reported. The authors concluded that the effect was probably due to sexual transmission and a negative influence on tubal function of the female person partner, since male C. trachomatis IgG positivity was correlated to female TFI. At that place was no such correlation between C. trachomatis IgG antibodies in the male and TFI in the present study, suggesting that in that location might be culling or additional mechanism(s) that can reduce fertility. Several studies have addressed the relationship between C. trachomatis IgG and IgA antibodies in serum and semen and sperm quality but few significant relationships have been shown (Bjercke and Purvis, 1992; Dieterle et al., 1995; Eggert‐Kruse et al., 1996; Weidner et al., 1996; Habermann and Krause, 1999; Ochsendorf et al., 1999). However, Gdoura et al. (2001) constitute an association between C. trachomatis Dna in semen and reduced sperm motility. In this context it is interesting to note that a recent study has demonstrated that co‐incubation of sperm for 1–6 h with C. trachomatis serovar E increased the proportion of immotile and expressionless sperm ( Hosseinzadeh et al., 2001).

In decision, we advise that C. trachomatis antibiotic testing of both the male and female partner of the couple should be included in the routine infertility work‐up in guild to enable a more acceptable prognosis for the likelihood of a spontaneous pregnancy. It remains to be seen in a randomized controlled study if antibiotic handling to C. trachomatis IgG positive infertile patients and/or to all, as suggested by Country et al. (2002), will increment the couple's likelihood to achieve pregnancy in spontaneous and/or assisted reproductive cycles.

Acknowledgements

The authors wish to express their gratitude to nurse coordinator Åsa Hampusson, laboratory piece of work by Iréne Eriksson and statistical communication from Nils‐Gunnar Pehrsson. This piece of work was supported by grants from the Swedish Medical Inquiry Council 13144 (J.I.O.) and past the Medical Faculty at Umeå Academy.

Tabular array I.

Diagnoses, treatments and pregnancies

No. of couples %
Principal diagnoses 244 100.0
 Not specifieda 74 30.3
 Anovulation 43 17.half-dozen
 Tubal factor 37 xv.2
 Male factor 36 fourteen.eight
 Unexplained 27 xi.i
 Endometriosis 26 10.seven
 Uterine anomalies one 0.four
Treatments
 None 118 48.3
 Ovulation inductionb 49 twenty.i
 IVF 32 xiii.1
 ICSI 25 10.two
 AIH or AID 20 eight.ii
Achieved pregnancy 150 61.5
 Spontaneously 88 58.7
 Treatment‐related 62 41.3
No. of couples %
Principal diagnoses 244 100.0
 Not specifieda 74 30.3
 Anovulation 43 17.6
 Tubal factor 37 fifteen.2
 Male person factor 36 14.8
 Unexplained 27 11.ane
 Endometriosis 26 10.7
 Uterine anomalies 1 0.iv
Treatments
 None 118 48.3
 Ovulation inductionb 49 20.1
 IVF 32 13.1
 ICSI 25 10.2
 AIH or AID xx eight.2
Achieved pregnancy 150 61.5
 Spontaneously 88 58.7
 Treatment‐related 62 41.iii

aThis applies mainly to those couples who either conceived earlier the investigation was completed (58/73: one lost to follow‐upwards, 79.5%) or who decided to discontinue the investigation for personal reasons.

bClomiphene citrate stimulation or recombinant FSH stimulation.

AIH = artificial insemination with husband's sperm; Help = artificial insemination with donor sperm.

Table I.

Diagnoses, treatments and pregnancies

No. of couples %
Principal diagnoses 244 100.0
 Not specifieda 74 30.3
 Anovulation 43 17.half dozen
 Tubal factor 37 15.ii
 Male person factor 36 fourteen.8
 Unexplained 27 11.1
 Endometriosis 26 10.7
 Uterine anomalies ane 0.iv
Treatments
 None 118 48.iii
 Ovulation inductionb 49 twenty.i
 IVF 32 13.1
 ICSI 25 10.2
 AIH or Assistance xx 8.2
Achieved pregnancy 150 61.5
 Spontaneously 88 58.7
 Treatment‐related 62 41.3
No. of couples %
Chief diagnoses 244 100.0
 Non specifieda 74 30.3
 Anovulation 43 17.6
 Tubal factor 37 fifteen.2
 Male factor 36 fourteen.8
 Unexplained 27 xi.1
 Endometriosis 26 10.seven
 Uterine anomalies one 0.4
Treatments
 None 118 48.3
 Ovulation consecrationb 49 twenty.1
 IVF 32 13.1
 ICSI 25 10.2
 AIH or Aid 20 viii.2
Accomplished pregnancy 150 61.5
 Spontaneously 88 58.seven
 Treatment‐related 62 41.three

aThis applies mainly to those couples who either conceived before the investigation was completed (58/73: one lost to follow‐up, 79.5%) or who decided to discontinue the investigation for personal reasons.

bClomiphene citrate stimulation or recombinant FSH stimulation.

AIH = artificial insemination with husband's sperm; AID = artificial insemination with donor sperm.

Table II.

Prevalence of IgG and DNA positivity

IgG prevalence Deoxyribonucleic acid prevalence among testeda
No. of patients % No. of patients %
Women 59/244 24.ii 5/74 six.8
Men 49/243 20.1 v/70 7.i
Couplesb 78/244 32.0 ix/68 xiii.2
IgG prevalence Dna prevalence among testeda
No. of patients % No. of patients %
Women 59/244 24.ii five/74 6.8
Men 49/243 20.ane v/70 7.one
Couplesb 78/244 32.0 9/68 13.two

aBoth partners of a couple where the adult female, the man or both were positive in IgG‐testing were tested with PCR on first‐void urine specimen.

bRefers to number of couples where at least one of the partners was positive.

Table Ii.

Prevalence of IgG and DNA positivity

IgG prevalence DNA prevalence among testeda
No. of patients % No. of patients %
Women 59/244 24.2 v/74 6.eight
Men 49/243 xx.ane 5/70 7.i
Couplesb 78/244 32.0 9/68 13.2
IgG prevalence DNA prevalence among testeda
No. of patients % No. of patients %
Women 59/244 24.2 v/74 six.8
Men 49/243 20.1 5/70 7.1
Couplesb 78/244 32.0 9/68 xiii.2

aBoth partners of a couple where the woman, the man or both were positive in IgG‐testing were tested with PCR on first‐void urine specimen.

bRefers to number of couples where at least one of the partners was positive.

Table III.

Analyses of correlations

Relationships Odds ratio 95% CI Unadjusted P values Bonferroni–Holm adjusted P values
Probability of IgG+ homo if IgG+ woman vii.01 3.54–13.89 0.0005a 0.006a
Probability of having TFI if:
 IgG+ woman 3.57 one.59–viii.01 0.002a 0.02a
 IgG+ human being 1.53 0.72–iii.23 0.27
If the adult female is >35 years (northward = 49), probability of:
 the adult female being IgG+ 1.51 0.76–iii.03 0.26
 not achieving pregnancy 2.08 1.10–3.94 0.03a 0.24
Probability of not achieving pregnancy if:
 the woman is IgG+ 1.55 0.85–2.82 0.xv
 the man is IgG+ 2.56 1.33–4.90 0.005a 0.045a
Probability of not achieving pregnancy with IVF (n = 32) if:
 the woman is IgG+ 4.twenty 0.91–19.forty 0.xiii
 the man is IgG+ 2.00 0.39–10.16 0.43
Probability of not achieving pregnancy amidst couples with TFI as their main diagnosis (northward = 37) if:
 the woman is IgG+ 4.27 ane.06–17.36 0.050
 the man is IgG+ 1.70 0.39–vii.36 0.71
Relationships Odds ratio 95% CI Unadjusted P values Bonferroni–Holm adjusted P values
Probability of IgG+ homo if IgG+ adult female 7.01 3.54–thirteen.89 0.0005a 0.006a
Probability of having TFI if:
 IgG+ adult female 3.57 1.59–8.01 0.002a 0.02a
 IgG+ man 1.53 0.72–iii.23 0.27
If the adult female is >35 years (northward = 49), probability of:
 the woman being IgG+ 1.51 0.76–3.03 0.26
 non achieving pregnancy 2.08 1.10–3.94 0.03a 0.24
Probability of not achieving pregnancy if:
 the woman is IgG+ i.55 0.85–ii.82 0.15
 the human being is IgG+ 2.56 1.33–4.ninety 0.005a 0.045a
Probability of not achieving pregnancy with IVF (n = 32) if:
 the woman is IgG+ 4.twenty 0.91–19.40 0.13
 the man is IgG+ 2.00 0.39–10.xvi 0.43
Probability of not achieving pregnancy amongst couples with TFI as their primary diagnosis (n = 37) if:
 the woman is IgG+ 4.27 ane.06–17.36 0.050
 the man is IgG+ i.70 0.39–seven.36 0.71

a P <0.05 indicates statistical significance.

Table Three.

Analyses of correlations

Relationships Odds ratio 95% CI Unadjusted P values Bonferroni–Holm adapted P values
Probability of IgG+ man if IgG+ woman 7.01 three.54–thirteen.89 0.0005a 0.006a
Probability of having TFI if:
 IgG+ woman 3.57 1.59–8.01 0.002a 0.02a
 IgG+ man i.53 0.72–iii.23 0.27
If the woman is >35 years (n = 49), probability of:
 the woman beingness IgG+ 1.51 0.76–3.03 0.26
 non achieving pregnancy 2.08 ane.10–iii.94 0.03a 0.24
Probability of not achieving pregnancy if:
 the adult female is IgG+ 1.55 0.85–2.82 0.fifteen
 the homo is IgG+ 2.56 1.33–iv.xc 0.005a 0.045a
Probability of not achieving pregnancy with IVF (north = 32) if:
 the woman is IgG+ 4.twenty 0.91–19.40 0.thirteen
 the man is IgG+ 2.00 0.39–10.16 0.43
Probability of not achieving pregnancy among couples with TFI as their main diagnosis (n = 37) if:
 the adult female is IgG+ iv.27 i.06–17.36 0.050
 the man is IgG+ ane.70 0.39–vii.36 0.71
Relationships Odds ratio 95% CI Unadjusted P values Bonferroni–Holm adjusted P values
Probability of IgG+ man if IgG+ adult female 7.01 iii.54–13.89 0.0005a 0.006a
Probability of having TFI if:
 IgG+ adult female 3.57 i.59–8.01 0.002a 0.02a
 IgG+ human 1.53 0.72–3.23 0.27
If the adult female is >35 years (n = 49), probability of:
 the woman being IgG+ ane.51 0.76–iii.03 0.26
 not achieving pregnancy ii.08 1.10–iii.94 0.03a 0.24
Probability of not achieving pregnancy if:
 the adult female is IgG+ ane.55 0.85–2.82 0.fifteen
 the man is IgG+ 2.56 1.33–4.90 0.005a 0.045a
Probability of non achieving pregnancy with IVF (n = 32) if:
 the woman is IgG+ 4.20 0.91–19.forty 0.13
 the homo is IgG+ 2.00 0.39–x.sixteen 0.43
Probability of not achieving pregnancy amidst couples with TFI as their main diagnosis (n = 37) if:
 the woman is IgG+ iv.27 ane.06–17.36 0.050
 the man is IgG+ 1.70 0.39–7.36 0.71

a P <0.05 indicates statistical significance.

Table IV.

Chlamydia trachomatis IgG and pregnancy upshot in spontaneous or handling‐ related pregnancies

IgG– IgG+
No. of couples % No. of couples %
Men
 Births 96 75.0 18 85.7
 Spontaneous abortion 27 21.1 two 9.5
 Ectopic pregnancy v three.9 i 4.8
 Full 129 100.0 21 100.0
Women
 Births 90 76.3 24 75.0
 Spontaneous ballgame 25 21.2 v xv.half dozen
 Ectopic pregnancy 3 2.five three ix.4
 Total 118 100.0 32 100.0
IgG– IgG+
No. of couples % No. of couples %
Men
 Births 96 75.0 xviii 85.7
 Spontaneous abortion 27 21.1 two nine.v
 Ectopic pregnancy five 3.9 ane iv.8
 Total 129 100.0 21 100.0
Women
 Births 90 76.3 24 75.0
 Spontaneous ballgame 25 21.2 5 15.6
 Ectopic pregnancy three two.5 three 9.4
 Total 118 100.0 32 100.0

There were no statistically significant differences between IgG– and IgG+ couples concerning pregnancy outcome.

Table Four.

Chlamydia trachomatis IgG and pregnancy outcome in spontaneous or handling‐ related pregnancies

IgG– IgG+
No. of couples % No. of couples %
Men
 Births 96 75.0 xviii 85.7
 Spontaneous abortion 27 21.1 2 9.5
 Ectopic pregnancy 5 iii.ix 1 four.8
 Total 129 100.0 21 100.0
Women
 Births 90 76.3 24 75.0
 Spontaneous abortion 25 21.2 five 15.vi
 Ectopic pregnancy 3 ii.5 3 ix.4
 Total 118 100.0 32 100.0
IgG– IgG+
No. of couples % No. of couples %
Men
 Births 96 75.0 xviii 85.vii
 Spontaneous abortion 27 21.ane 2 9.5
 Ectopic pregnancy v 3.9 i 4.8
 Total 129 100.0 21 100.0
Women
 Births 90 76.iii 24 75.0
 Spontaneous ballgame 25 21.2 5 fifteen.six
 Ectopic pregnancy three 2.five three 9.4
 Full 118 100.0 32 100.0

There were no statistically significant differences between IgG– and IgG+ couples concerning pregnancy upshot.

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