Chlamydia testing in infertility management

In the majority of women, chlamydia infections occur during adolescence, and remain asymptomatic. These unrecognized and untreated infections may increase the risk for tubal factor subfertility at a later age. Since the association between chlamydia IgG antibodies in serum and tubal pathology was noticed, chlamydia antibody testing (CAT) has been used in the fertility work-up as an inexpensive and non-invasive screening test for tubal factor subfertility. The predictive value of CAT is limited, however, and clinicians should be aware of factors known to affect the diagnostic accuracy of CAT (such as test and cut-off titre used, and definition of tubal factor subfertility). Women who undergo uterine instrumentation (e.g. hysterosalpingography and laparoscopy with hydrotubation) are considered at risk for pelvic infections. In subfertile women, the incidence of active chlamydia infections is low (1-2%). But since the presence of viable chlamydia micro-organisms in their upper genital tracts cannot be excluded, prophylactic antibiotics before uterine instrumentation should be considered in all subfertile women, instead of endocervical screening for C. trachomatis and treatment of positive cases only.