Recent evidence suggests that Chlamydia trachomatis can persist in the female upper genital tract in an unculturable state. Since unsuspected C. trachomatis infection has been associated with adverse in-vitro fertilization (IVF) outcome we sought to detect further evidence of C. trachomatis in the genital tracts of women undergoing IVF. The prevalence and distribution of antibodies to the major structural proteins of C. trachomatis in paired follicular fluid and sera of women undergoing IVF were examined. Sera and follicular fluid samples from 149 women were assayed for immunoglobulin (Ig)G and IgA antibodies to two C. trachomatis antigens, the major outer membrane protein (MOMP) and a recombinant lipopolysaccharide (rLPS) fragment. Additionally, the expression of human 60 kDa heat shock protein (hsp 60) in follicular fluid was determined. All cervical and follicular fluid samples were negative for C. trachomatis by polymerase chain reaction, ligase chain reaction and DNA probe. Sera from 60% of the subjects were positive for antichlamydial rLPS IgG; 36% were positive for anti-MOMP IgG. Similarly, rLPS-directed and MOMP-directed IgA were detected in sera of 34 and 14% of the subjects respectively. IgG antibodies to MOMP and rLPS were detected in 42 and 41% of the follicular fluid examined respectively. Anti-MOMP IgA was identified in 8.7% of the follicular fluid while 27.5% were positive for anti-rLPS IgA. Human hsp 60 expression was documented in 11.6% of the follicular fluid tested. IgA antibodies to both MOMP (P = 0.03) and rLPS (P = 0.02) in follicular fluid were associated with a failure to become pregnant after embryo transfer. IgG antibodies in sera and follicular fluid and IgA antibodies in sera were unrelated to IVF outcome. Similarly only anti-MOMP IgA (P = 0.02) and anti-rLPS IgA (P = 0.04) in follicular fluid were correlated with human hsp 60 expression in follicular fluid. The unique association between IgA antibodies to two chlamydial antigens in follicular fluid and both hsp 60 expression and IVF failure provides further support for the possibility that a persistent upper genital tract chlamydial infection contributes to IVF failure in some women.

译文

最近的证据表明,沙眼衣原体可以在女性上生殖道中以无法培养的状态持续存在。由于未曾怀疑的沙眼衣原体感染与体外受精(IVF)不良结果有关,因此我们寻求在接受IVF的女性生殖道中发现沙眼衣原体的进一步证据。检查了在进行IVF的妇女的成对卵泡液和血清中沙眼衣原体主要结构蛋白的抗体的分布情况。分析了来自149名妇女的血清和卵泡液样品中针对两种沙眼衣原体抗原,主要外膜蛋白(MOMP)和重组脂多糖(rLPS)片段的免疫球蛋白(Ig)G和IgA抗体。另外,测定了人60kDa热休克蛋白(hsp 60)在卵泡液中的表达。通过聚合酶链反应,连接酶链反应和DNA探针,所有子宫颈和卵泡液样品均为沙眼衣原体阴性。 60%的受试者血清抗衣原体rLPS IgG阳性; 36%的抗MOMP IgG阳性。同样,分别在34%和14%的受试者血清中检测到了rLPS导向和MOMP导向的IgA。在分别检查的卵泡液中有42%和41%检出了针对MOMP和rLPS的IgG抗体。在8.7%的卵泡液中发现了抗MOMP IgA,而抗rLPS IgA的阳性率为27.5%。在测试的卵泡液中有11.6%记录了人类hsp 60的表达。卵泡液中针对MOMP(P = 0.03)和rLPS(P = 0.02)的IgA抗体与胚胎移植后无法怀孕有关。血清和卵泡液中的IgG抗体以及血清中的IgA抗体与IVF结果无关。同样,卵泡液中只有抗MOMP IgA(P = 0.02)和抗rLPS IgA(P = 0.04)与人hsp 60在卵泡液中的表达相关。卵泡液中针对两种衣原体抗原的IgA抗体与hsp 60表达和IVF衰竭之间的独特联系为某些女性持续性上生殖道衣原体感染导致IVF衰竭的可能性提供了进一步的支持。

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