Elevated serum Chlamydia trachomatis IgG antibodies. What do they mean for IVF pregnancy rates and loss?
OBJECTIVE
To evaluate the impact of elevated serum Chlamydia IgG antibodies (Ab) on in vitro fertilization (IVF) outcome in a large infertility population.


METHODS
One hundred ninety-four women under 40 years of age undergoing a total of 316 IVF cycles were evaluated. All couples with positive serum Chlamydia IgG Ab were pretreated with doxycycline, 100 mg twice daily, for 10 days prior to the first IVF cycle.


RESULTS
One hundred seven women (55.2%) had elevated serum Chlamydia IgG Ab. One hundred seventy-two IVF cycles (54.4%) were in patients with elevated Ab as compared to 144 cycles (45.6%) in controls with negative Ab. There were no significant differences in mean age, number of mature oocytes obtained or number of embryos transferred between the two groups. Patients with elevated IgG Ab had on ongoing pregnancy rate of 30.2% (52/172) and implantation rate of 13.5% (101/746) as compared to 34.7% (50/144) and 13.6% (88/649) in the negative Ab group, respectively (P = NS for both). Two ectopic pregnancies occurred in the elevated Ab group (1.2%, 2/172) vs. none in the negative Ab group. The incidence of early pregnancy loss was 8.7% (15/172) and 9.7% (14/144) in the positive and negative Ab groups, respectively (P = NS).


CONCLUSIONS
The prevalence of elevated serum Chlamydia IgG Ab in patients presenting for IVF was higher than in the general population. In the absence of an active genital tract infection, the presence of elevated serum Chlamydia IgG Ab was not associated with a poor IVF outcome when couples were treated with antibiotics prior to stimulation. In addition, there was no correlation between IVF outcome and quantitative IgG Ab titers in women with elevated serum Chlamydia Ab. We recommend that all couples with elevated titers be treated with doxycycline prior to the first IVF attempt to optimize pregnancy rates and minimize infectious complications.
Sharara
F I
FI
Department of Obstetrics and Gynecology, University of Illinois College of Medicine, Chicago, USA.
Queenan
J T
JT
Springer
R S
RS
Marut
E L
EL
Scoccia
B
B
Scommegna
A
A
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood*; D002690:Chlamydia Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D002692:Chlamydia trachomatis / Q000276:immunology*; D004318:Doxycycline / Q000627:therapeutic use; D010064:Embryo Implantation; D005260:Female; D005307:Fertilization in Vitro; D005455:Fluorescent Antibody Technique; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011446:Prospective Studies
D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D004318:Doxycycline