title: Screening strategies for tubal factor subfertility.
abstract: BACKGROUND
  Different screening strategies exist to estimate the risk of tubal factor subfertility, preceding laparoscopy. Three screening strategies, comprising Chlamydia trachomatis IgG antibody testing (CAT), high-sensitivity C-reactive protein (hs-CRP) testing and hysterosalpingography (HSG), were explored using laparoscopy as reference standard and the occurrence of a spontaneous pregnancy as a surrogate marker for the absence of tubal pathology.
  
  
  METHODS
  In this observational study, 642 subfertile women, who underwent tubal testing, participated. Data on serological testing, HSG, laparoscopy and interval conception were collected. Multiple imputations were used to compensate for missing data.
  
  
  RESULTS
  Strategy A (HSG) has limited value in estimating the risk of tubal pathology. Strategy B (CAT-->HSG) shows that CAT significantly discerns patients with a high versus low risk of tubal pathology, whereas HSG following CAT has no additional value. Strategy C (CAT-->hs-CRP-->HSG) demonstrates that hs-CRP may be valuable in CAT-positive patients only and HSG has no additional value.
  
  
  CONCLUSIONS
  CAT is proposed as first screening test for tubal factor subfertility. In CAT-negative women, HSG may be performed because of its high specificity and fertility-enhancing effect. In CAT-positive women, hs-CRP seems promising, whereas HSG has no additional value. The position and timing of laparoscopy deserves critical reappraisal.
authors.affiliation: Research Institute Growth and Development (GROW), Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands. je_denhartog@hotmail.com
authors.forename: J E
authors.initials: JE
authors.lastname: den Hartog
authors.forename: C M J G
authors.initials: CM
authors.lastname: Lardenoije
authors.forename: J L
authors.initials: JL
authors.lastname: Severens
authors.forename: J A
authors.initials: JA
authors.lastname: Land
authors.forename: J L H
authors.initials: JL
authors.lastname: Evers
authors.forename: A G H
authors.initials: AG
authors.lastname: Kessels
mesh_terms: D000328:Adult; D000907:Antibodies, Bacterial / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D002690:Chlamydia Infections / Q000175:diagnosis / Q000276:immunology; D002692:Chlamydia trachomatis / Q000276:immunology; D005184:Fallopian Tube Diseases / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007047:Hysterosalpingography; D007247:Infertility, Female / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D011237:Predictive Value of Tests; D011247:Pregnancy
chemical_list: D000907:Antibodies, Bacterial; D002097:C-Reactive Protein