Tubal pelvic damage: prediction and prognosis

Relationship between Chlamydia Trachomatis Infection with Patency Tubal and Non-Patency Tubal Occurrence in Infertile Women

AIM

To determine the relationship between Chlamydia Trachomatis infections with patency tubal and non-patency tubal occurrence in infertile women.

METHODS

This research was an observational analytic research with a cross-sectional study. This research was conducted at Haji Adam Malik General Hospital Medan, Pramita Laboratory Medan and Medical Faculty of Medicine Universitas Sumatera Utara. Laboratory on October 2017 until the number of samples was fulfilled. The samples were women who were referred to Pramita Laboratory Medan for hysterosalpingography procedure in accordance which corresponded to the inclusion criteria by using consecutive sampling technique.

RESULTS

From this research, it was found that the most infertile women were aged 31-35 years, with the most infertility type was primary infertility (83,8%) with the longest infertility duration was ≥ 3 years (44%). From all samples who were infertile, 26% among them were positive to chlamydia infection. Eight from twelve people who were infected by Chlamydia Trachomatis experienced non-patency tubal (66.7%) with p-value = 0.001 which showed that there was a relationship between Chlamydia Trachomatis infection with patency tubal and non-patency tubal occurrence in infertile women.

CONCLUSION

The proportion of Chlamydia Trachomatis infection in tubal abnormality in this study was 66.7%, whereas Chlamydia Trachomatis infection in the normal tube was 13.2%. It was obtained that there was a significant relationship between Chlamydia Trachomatis infection with tubal abnormality (non-patency tubal) with p-value < 0.005 (p = 0.001).

[Prevalence and role of IgG anti-Chlamydia trachomatis in a population of infertile men in Morocco]

INTRODUCTION

Infertility is a global public health problem that affects 15% of couples of childbearing age. Male infertility is involved in 20 to 50% of cases. These figures are sharply increasing around the world. Several factors may be responsible for this infertility with especially hormonal, genetic, toxic or infectious factors. The latter are dominated mainly by Chlamydia infection. Among the most serious complications of this infection are infertility related to urethritis, epididymitis and irreversible total azoospermia in men and tubal obstructions and ectopic pregnancies in women.

STUDY OBJECTIVE

To determine the prevalence of IgG anti-Chlamydia trachomatis in men consulting for infertility and the association between previous contact with this bacterium and the impairment of sperm quality and sperm function.

MATERIAL AND METHODS

Prospective study over 26months of 143 patients referred to the service for infertility assessment of the couple. Demographic data, primary or secondary character of infertility, risk factors (tobacco, inguinal hernia, varicocele and history of urogenital infections), semen parameters (volume, mobility, pH, vitality and morphological abnormalities) were studied as well as the determination of the anti-C. trachomatis IgG titer. The prevalence of Chlamydia infection and the association of the infection and alteration of the various parameters of the semen were analyzed.

RESULTS

The average age of patients was 38.5±8.55. Infertility was primary in 72% of patients. Among the patients, 54.5% had an abnormal spermogram. Chlamydia IgG antibodies were positive in 37.1% of patients whose 58.5% had abnormal spermogram. Analysis of sperm parameters of patients with and without IgG C. trachomatis showed an altered vitality in Chlamydia positive patients with an OR at 2.41, P=0.02, (95% CI: 1.15-5.06).

CONCLUSION

The prevalence of Chlamydia infection is high in infertile male. C. trachomatis IgG antibodies may be associated with an alteration of spermatozoa vitality without significant impairment of other semen parameters.

LEVEL OF EVIDENCE

3.

Impact of Chlamydia trachomatis in the reproductive setting: British Fertility Society Guidelines for practice

Chlamydia trachomatis infection of the genital tract is the most common sexually transmitted infection and has a world-wide distribution. The consequences of infection have an adverse effect on the reproductive health of women and are a common cause of infertility. Recent evidence also suggests an adverse effect on male reproduction. There is a need to standardise the approach in managing the impact of C. trachomatis infection on reproductive health. We have surveyed current UK practice towards screening and management of Chlamydia infections in the fertility setting. We found that at least 90% of clinicians surveyed offered screening. The literature on this topic was examined and revealed a paucity of solid evidence for estimating the risks of long-term reproductive sequelae following lower genital tract infection with C. trachomatis. The mechanism for the damage that occurs after Chlamydial infections is uncertain. However, instrumentation of the uterus in women with C. trachomatis infection is associated with a high risk of pelvic inflammatory disease, which can be prevented by appropriate antibiotic treatment and may prevent infected women from being at increased risk of the adverse sequelae, such as ectopic pregnancy and tubal factor infertility. Recommendations for practice have been proposed and the need for further studies is identified.

Morphology of human Fallopian tubes after infection with Mycoplasma genitalium and Mycoplasma hominis--in vitro organ culture study

BACKGROUND

Female infertility can be caused by scarring and occlusion of the Fallopian tubes. Sexually transmitted bacteria can damage the delicate epithelial layer of human Fallopian tubes (HFT). Genital mycoplasmas are associated with human reproductive failure. Yet, there is not enough evidence that mycoplasmas can cause tubal factor infertility. We analysed the effects of infections with Mycoplasma hominis and Mycoplasma genitalium on the HFT epithelium and compared them with the effects of infections with genital pathogens: Chlamydia trachomatis and Neisseria gonorrhoeae.

METHODS

We used an in vitro model in which pieces of normal HFT were infected with different bacteria, and the outcome of the infections was analysed by scanning electron microscopy (SEM) and confocal microscopy.

RESULTS

The presence of M. hominis did not cause any morphological changes of the epithelium of HFT. Noticeable changes in the morphology of the ciliated cells were observed in M. genitalium-infected tissue. Five days post-infection, the cilia were abnormally swollen and some of the ciliated cells fell off the epithelium. These effects could be inhibited by pre-incubation of M. genitalium with antibody directed against the C-terminal part of the adhesion protein MgPa before infection of HFT organ culture.

CONCLUSION

We have shown that the presence of M. genitalium, but not M. hominis, in the HFT organ culture affected the epithelium and resulted in cilia damage. The effect of infection with M. genitalium on the HFT was, however, very moderate when compared with the extensive damage of the epithelium caused by N. gonorrhoeae or C. trachomatis.

The predictive value of the ‘Hull & Rutherford’ classification for tubal damage

OBJECTIVE

This study explores the predictive value for live birth following tubal reconstructive surgery of the "Hull & Rutherford" (H&R) classification system.

DESIGN

Retrospective cohort study.

SETTING

Tertiary infertility referral service, University of Bristol.

POPULATION

Infertile women younger than 40 years with tubal damage undergoing tubal surgery.

METHODS

Women (n= 192) were grouped according to three severity grades of disease based on the H&R classification. Essentially, the main features of grade I tubal damage were filmy adhesions, whereas grades II and III referred to unilateral severe damage and bilateral severe damage, respectively. Standard surgical techniques were employed. Pregnancy and live birth rates were calculated and compared using time-specific univariate Kaplan-Maier curves and multivariate Cox's regression analysis.

MAIN OUTCOME MEASURES

Pregnancy, ectopic and live birth within three years of surgery.

RESULTS

A significant trend towards higher ectopic pregnancy rates (P < 0.001) with increasing severity of tubal damage was noted, but not miscarriage rates. Univariate analysis revealed significant differences in the live birth rates of 69%, 48% and 9% for grades I, II and III, respectively. Multivariate analysis (controlling for age, duration of and primary infertility) confirmed these differences to be significant with risk ratios of 13.7 (95% CI: 4.49-41.9) and 6.54 (95% CI: 2.48-17.24) for grades I and II disease, respectively, compared with grade III disease, used as the reference.

CONCLUSIONS

The H&R classification is a simple classification system that is able to distinguish women into three distinct groups giving a favourable, fair and poor prognosis for live birth following tubal surgery.