Acta Obstet Gynecol Scand 58: 301 - 303, 1979
INFERTILITY AND CERVICAL CHLAMYDIA TRACHOMATIS INFECTIONS J.A. Paavonen, P. Saikku, E. Vesterinen and P. Lehtovirta From the Departments of Obstetrics and Gynecology I-II, University Central Hospital, and the Department of Virology, University of Helsinki, Helsinki, Finland
Abstract. Of the 51 women examined for infertility, 19.6 per cent were found Chl. trachomatis culture-positive. This differs, although not significantly, from the 9 per cent isolation rate among our general gynecological outpatients. T h e results suggest that Chi. trachomatis should be considered in women with unexplained infertility.
Chlamydiae are intracellular inclusion forming parasites, and man is the only known host for Chlamydia trachomatis, causing trachoma, inclusion conjunctivitis, lymphogranuloma venereum and genitourinary infections (1 1). Recent studies indicate that ChI. trachomatis is a fairly common inhabitant of the female genital tract (3, 5, 7 , 9, 13). An important question is the possible role of untreated chlamydial infection in female infertility. In some animals, sterility has been attributed to chlamydial diseases (12). Women with persistent Chl. trachomatis infection are unlikely to be diagnosed unless isolation of the agent is attempted, since distinctive symptoms or signs are not always present (6, 7). The aim of this work was to study the possible role of chlamydial genital infection in female infertility.
MATERIAL AND METHODS The subjects were 51 consecutive infertility patients, who attended the fertility outpatient clinic in Departments of Obstetrics and Gynecology 1-11, University Central Hospital, Helsinki, Finland, in December 1976. There was no preselection of the patients. Only those were excluded, who had taken antibiotics or sulphonamides during the last month. All the patients had visited this outpatient clinic several times and were examinated carefully concerning etiological factors in infertility. Routine tests included basal body temperature (BBT), vaginal smear for hormonal test, serum Progesterone, hysterosalpingography (HSG), post coital test (PCT) and partner’s semen analysis. Specimens for chlamydial isolation were collected with sterile cottonwool swabs from endocervix and urethra into 2 SP-transport medium (2) further buffered with 0.75 per cent
bovine albumin. Gentamicin 20 fig/ml was used as antibiotic. Specimens were transferred immediately at 4°C and transported the same day to the isolation unit in the same hospital complex, where they were stored at -7OOC. Isolation attempts were done conventionally (1) in irradiated Mc Coy cells with minor modifications. Growth medium was Eagle’s minimal essential medium with double amounts of amino acids and vitamins supplemented with 10 per cent fetal calf serum (Gibco) and 1 per cent glucose and gentamicin 20 pg/ml. This was used as maintenance medium with additional nystatin 500 unitdml. Monolayers were grown onto coverslips 13 mm in diameter in 5 ml Bijou bottles (Sterilin). Samples were centrifuged onto coverslips, in a Sorvall ultracentrifuge equipped with a swing-out head, at 6000 G for one hour at 35°C. After incubation for 72 hours in a humidified 5 per cent CO, atmosphere, the coverslips were fixed with methanol and stained for 15 min with Lugol’s solution to demonstrate iodine positive Chl. trachomatis inclusions.
RESULTS Of the 51 patients studied, 10 (19.6 per cent) excreted Chl. trachomatis (Table I). The mean age of the patients was 29.1 years (range 22 to 38). The age distribution of the patients is shown in Table 11. The definitions of infertility were similar among chlamydia-positive and -negative patients (Table 111). No abnormalities of the cervix were observed among chlamydia-positive patients. In three cases the vaginal smear taken for hormonal test showed inflammatory reaction. The distribution of known etiological factors of infertility was rather similar in the two patient groups (table IV), except that the etiology of infertility remained unexplained in 5/10 chlamydia-positive patients but in only 7/41 (17 per cent) chlamydia-negative patients. This difference is, however, statistically not significant (x2= 3,19, p
INFERTILITY AND CERVICAL CHLAMYDIA TRACHOMATIS INFECTIONS J.A. Paavonen, P. Saikku, E. Vesterinen and P. Lehtovirta From the Departments of Obstetrics and Gynecology I-II, University Central Hospital, and the Department of Virology, University of Helsinki, Helsinki, Finland
Abstract. Of the 51 women examined for infertility, 19.6 per cent were found Chl. trachomatis culture-positive. This differs, although not significantly, from the 9 per cent isolation rate among our general gynecological outpatients. T h e results suggest that Chi. trachomatis should be considered in women with unexplained infertility.
Chlamydiae are intracellular inclusion forming parasites, and man is the only known host for Chlamydia trachomatis, causing trachoma, inclusion conjunctivitis, lymphogranuloma venereum and genitourinary infections (1 1). Recent studies indicate that ChI. trachomatis is a fairly common inhabitant of the female genital tract (3, 5, 7 , 9, 13). An important question is the possible role of untreated chlamydial infection in female infertility. In some animals, sterility has been attributed to chlamydial diseases (12). Women with persistent Chl. trachomatis infection are unlikely to be diagnosed unless isolation of the agent is attempted, since distinctive symptoms or signs are not always present (6, 7). The aim of this work was to study the possible role of chlamydial genital infection in female infertility.
MATERIAL AND METHODS The subjects were 51 consecutive infertility patients, who attended the fertility outpatient clinic in Departments of Obstetrics and Gynecology 1-11, University Central Hospital, Helsinki, Finland, in December 1976. There was no preselection of the patients. Only those were excluded, who had taken antibiotics or sulphonamides during the last month. All the patients had visited this outpatient clinic several times and were examinated carefully concerning etiological factors in infertility. Routine tests included basal body temperature (BBT), vaginal smear for hormonal test, serum Progesterone, hysterosalpingography (HSG), post coital test (PCT) and partner’s semen analysis. Specimens for chlamydial isolation were collected with sterile cottonwool swabs from endocervix and urethra into 2 SP-transport medium (2) further buffered with 0.75 per cent
bovine albumin. Gentamicin 20 fig/ml was used as antibiotic. Specimens were transferred immediately at 4°C and transported the same day to the isolation unit in the same hospital complex, where they were stored at -7OOC. Isolation attempts were done conventionally (1) in irradiated Mc Coy cells with minor modifications. Growth medium was Eagle’s minimal essential medium with double amounts of amino acids and vitamins supplemented with 10 per cent fetal calf serum (Gibco) and 1 per cent glucose and gentamicin 20 pg/ml. This was used as maintenance medium with additional nystatin 500 unitdml. Monolayers were grown onto coverslips 13 mm in diameter in 5 ml Bijou bottles (Sterilin). Samples were centrifuged onto coverslips, in a Sorvall ultracentrifuge equipped with a swing-out head, at 6000 G for one hour at 35°C. After incubation for 72 hours in a humidified 5 per cent CO, atmosphere, the coverslips were fixed with methanol and stained for 15 min with Lugol’s solution to demonstrate iodine positive Chl. trachomatis inclusions.
RESULTS Of the 51 patients studied, 10 (19.6 per cent) excreted Chl. trachomatis (Table I). The mean age of the patients was 29.1 years (range 22 to 38). The age distribution of the patients is shown in Table 11. The definitions of infertility were similar among chlamydia-positive and -negative patients (Table 111). No abnormalities of the cervix were observed among chlamydia-positive patients. In three cases the vaginal smear taken for hormonal test showed inflammatory reaction. The distribution of known etiological factors of infertility was rather similar in the two patient groups (table IV), except that the etiology of infertility remained unexplained in 5/10 chlamydia-positive patients but in only 7/41 (17 per cent) chlamydia-negative patients. This difference is, however, statistically not significant (x2= 3,19, p
