The limited clinical usefulness of taking a history in the evaluation of women with tubal factor infertility.
OBJECTIVE
To evaluate whether patient histories of gynecological infections predict tubal pathology seen at laparoscopic exam in infertile women.


METHODS
Cross-sectional analysis from a subset of case-control subjects.


METHODS
Tertiary-level public hospitals with infertility clinics, Mexico City.


METHODS
Three hundred twenty-one nulligravid infertile women seeking diagnostic workup.


METHODS
Interviews conducted before evaluation by laparoscopy.


METHODS
Sensitivity, specificity, and predictive values for correlating previous pelvic inflammatory disease symptoms, vaginal discharge, genital tract infections, and antibodies to Chlamydia trachomatis to confirmed diagnoses of tubal pathology and to severe tubal pathology.


RESULTS
Tubal pathology was found in 58% of participants (n = 185), and severe pathology was found in 29% (n = 92). None of the historical infection-related factors alone was a good overall predictor of tubal pathology; high sensitivity values (up to 73%) were offset by low specificity (down to 30%) and vice versa, for each factor. When considered simultaneously, the factors improved the overall predictive ability just slightly (84% sensitivity and 29% specificity) over the individual factors. The validity measures did not improve when examining severe tubal pathology alone.


CONCLUSIONS
History taking related to past genital tract infections appears to be of little use in the evaluation of infertile women.
Hubacher
David
D
Family Health International, Research Triangle Park, North Carolina 27709, USA. dhubacher@fhi.org
Grimes
David
D
Lara-Ricalde
Roger
R
de la Jara
Julio
J
Garcia-Luna
Alonso
A
D000328:Adult; D016022:Case-Control Studies; D002690:Chlamydia Infections / Q000175:diagnosis / Q000276:immunology; D002692:Chlamydia trachomatis / Q000276:immunology; D003430:Cross-Sectional Studies; D005184:Fallopian Tube Diseases / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D010535:Laparoscopy; D008487:Medical History Taking; D000292:Pelvic Inflammatory Disease / Q000150:complications; D011237:Predictive Value of Tests; D012044:Regression Analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014621:Vagina / Q000473:pathology