According to the World Health Organization (WHO), the reason for infertility is multi-factorial, including female factors, male factors and unexplained factors in some cases. The magnitude of infertile couples all over the world was found to be 60–80 million. It has been estimated to affect 8–12% of couples globally, and this may vary in different regions of the world [1]. Female factors include ovulation disorders (25%), tubal defects (22%), endometriosis (15%), pelvic adhesion (11%) and hyperprolactinemia (7%) [2]. Genital infection due to
This prospective cross-sectional study was done in a tertiary care hospital. Institutional Ethics Committee Clearance was obtained from the local ethics committee-TIREC (Ref. No: 1629/MICRO/2019) and written consent had been obtained from each patient after full explanation of the purpose and nature of all procedures used. Confidentiality was maintained. Fifty endocervical swabs were collected from women of reproductive age group attending infertility clinic and stored at −80 ºC.
DNA extraction was done with the Helini bacterial mini spin kit. The elute was used for
HSG was done to assess the tubal patency and USG was carried out to find out other abnormalities in all the cases.
Women of reproductive age
History of primary and secondary infertility
Abstinence from sexual intercourse for 72 hours before sample collection
Primary infertility refers to the couples who have not become pregnant at least once
Secondary infertility refers to the mother who is unable to become pregnant following the birth of a child
although not necessarily a live birth
Infertility due to congenital cause
Infertility due to male factor
Vaginal cream application/antibiotics in the last 30 days
Of the 50 patients, 43 (86%) had primary infertility, and 7 (14%) had secondary infertility. The mean age was 28.1 years. Eighteen (36%) had PID symptoms. Screening by HSG showed tubal block in four (8%) patients. USG showed features suggestive of PID (adenexal cyst/fimbrial cyst/paratubal cyst) in 11 (22%) patients. Thirty-one (62%) patients yielded growth from endocervical swabs submitted for routine culture. Most common organisms isolated were
Three (6%) were positive for
Distribution of
20–24 | 0 | 14 | 14 | 0.252 |
25–29 | 3 | 15 | 18 | Fisher's exact test |
30–34 | 0 | 13 | 13 | |
35–39 | 0 | 4 | 4 | |
>40 | 0 | 1 | 1 | |
3 | 47 | 50 |
STIs are responsible for 70% of PIDs [5]. PID is usually polymicrobial and recurrent episodes lead to infertility due to tubal defects. Chance of infertility increases after every episode of PID: it has been found to be 25% for the first episode, 50% following the second episode and 75% following the third episode [6].
Recurrence is common in young women due to the anatomic differences in the cervix; the squamocolumnar junction, which is the primary target for
Risk factors include being unmarried, nulliparity, race, poor socio-economic status, having multiple sexual partners, lack of use of barrier contraceptive devices, concurrent gonococcal infection and use of oral contraceptive [9].
Osborne et al. recorded that 80% of patients with PID showed antibodies to
Kulkarni et al. collected endocervical swabs from PID cases and found that 62% were aerobic culture positive. Organisms isolated were
High prevalence of
Most
Further, it is not widely available in all laboratories. Hence, an alternative, more feasible method is needed especially in resource poor settings [8].
The commonly used method is antigen detection by direct fluorescent antigen (DFA), which is 90% sensitive and 98–99% specific. High specificity depends on visualization of distinctive morphology and staining characteristics of
PCR is the sensitive and specific method in the diagnosis. A low prevalence of 6% was noted in this study which reflects active infection. Similar results were noted in studies conducted in India by Sood et al. (9.28%), and Dwibedi et al. (7.04%) using PCR among symptomatic females. [16,17]. As most of the patients are treated based on syndromic management, there is low prevalence of
Four patients (8%) had a tubal block detected by HSG. Of this only one was PCR positive. Quantitative RT-PCR detects the burden of organisms which may vary from 10 to over a million organisms per ml of genital tract secretions [18]. High load is associated with clinical symptoms, transmissibility, persistence of infection and complications.
In the present study, the samples were tested using PCR, but the results were not compared with DFA detection which is the gold standard test for detection of
Also, the IgG antibodies to
This study highlights the need for the screening for infectious etiology, along with USG and HSG examination among women with infertility. Routine screening of