Chlamydia antibody testing and diagnosing tubal pathology in subfertile women: an individual patient data meta-analysis

K A Broeze, B C Opmeer, S F P J Coppus, N Van Geloven, M F C Alves, G Anestad, S Bhattacharya, J Allan, M F Guerra-Infante, J E Den Hartog, J A Land, A Idahl, P J Q Van der Linden, J W Mouton, E H Y Ng, J W Van der Steeg, P Steures, H F Svenstrup, A Tiitinen, B ToyeF Van der Veen, B W Mol

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Abstract

Subfertility, defined as failure to conceive within 12 months despite
regular unprotected intercourse, occurs in 10% of couples (Mosher
and Pratt, 1991; Cahill and Wardle, 2002; Taylor, 2003). Besides ovulation
disorders and sperm defects, tubal pathology is one of the main
causes of subfertility. The prevalence of tubal pathology in subfertile
couples ranges between 10 and 30% (Evers, 2002).
There are many tests to diagnose tubal pathology, of which Chlamydia
IgG antibody test (CAT) testing, hysterosalpingography (HSG) and
diagnostic laparoscopy (DLS) with chromopertubation are most often
used (Broeze et al., 2009). Although guidelines on the fertility work-up
are not concordant, CAT is often recommended as a first-line test
(British National Collaborating Center for Women’s and Children’s
Health, 2004; Dutch Society of Obstetrics and Gynaecology, 2004).
Unlike HSG or DLS, CAT is non-invasive and inexpensive (Mol
et al., 1997). When negative, CAT is thought to avoid unnecessary
and invasive diagnostic testing, whereas in CAT positive women,
further testing can be performed early, avoiding long-term expectative
management (den Hartog et al., 2008). A conventional meta-analysis
reported that accuracy estimates of CAT for individual studies
ranged between 21 and 90% for sensitivity and between 29 and
100% for specificity, with a summary receiver operator characteristics
(ROC) estimating the accuracy of CAT to be moderate and comparable
to that of HSG (Mol et al., 1997).
Unfortunately, in the assessment of the diagnostic accuracy of
CAT and the comparison of different assays over the full range of
possible test results, conventional meta-analyses are impeded since
they are based on the data reported at study level and limited to
reported 2 × 2 tables. Pooling data to estimate overall accuracy is
complicated by the use of different assays and different, mostly
unreported, cut-off values in the included studies. Original data
underlying the publications possibly contain CAT results recorded
in a continuous rather than a dichotomized way, as well as information
on several CAT assays within a single study and could be
used to compare the accuracies of different tests (Broeze et al.,
2009).
The aim of this study was to assess the accuracy of several CAT
assays in diagnosing tubal pathology, using continuous test results in
an individual patient data (IPD) meta-analysis.
Original languageEnglish
Pages (from-to)301-310
Number of pages10
JournalHuman Reproduction Update
Volume17
Issue number3
Early online date12 Jan 2011
DOIs
Publication statusPublished - May 2011

Keywords

  • systematic review
  • individual patient data meta-analysis
  • chlamydia antibody test
  • tubal pathology

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    Broeze, K. A., Opmeer, B. C., Coppus, S. F. P. J., Van Geloven, N., Alves, M. F. C., Anestad, G., Bhattacharya, S., Allan, J., Guerra-Infante, M. F., Den Hartog, J. E., Land, J. A., Idahl, A., Van der Linden, P. J. Q., Mouton, J. W., Ng, E. H. Y., Van der Steeg, J. W., Steures, P., Svenstrup, H. F., Tiitinen, A., ... Mol, B. W. (2011). Chlamydia antibody testing and diagnosing tubal pathology in subfertile women: an individual patient data meta-analysis. Human Reproduction Update, 17(3), 301-310. https://doi.org/10.1093/humupd/dmq060