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British Fertility Society calls for more research into effects of Chlamydia on fertility

More research is urgently needed to assess the relative risks of infertility resulting from Chlamydia infections, according to new guidelines from the British Fertility Society (BFS). The guidelines, published in the journal Human Fertility, show that there is currently a lack of solid evidence for estimating the relative risks of adverse long-term reproductive consequences following Chlamydial infection in both men and women. They also highlight the importance of screening all new patients at fertility clinics for Chlamydial infection.

The British Fertility Society carried out a thorough review of published research to present evidence-based guidelines to help UK fertility clinics in their practice of screening and managing couples with possible Chlamydia infection. However, they found there are several areas where there is a lack of properly controlled studies to allow recommendations to be made.

The guidelines identified three areas where further research is particularly needed:

Dr Valentine Akande, lead author of the guidelines, said:

"Chlamydia is a common sexually transmitted disease, and if it isnít treated, infection can have a serious effect on reproductive health. In women, Chlamydia can lead to infertility, ectopic pregnancies and chronic pelvic pain, while in men, there is growing evidence that Chlamydia reduces sperm quality and function. It is very important that all patients presenting to fertility clinics are tested for Chlamydia to allow doctors to treat any infection and assess whether any damage has been caused to their fertility. As doctors, we need to be able to provide our patients with accurate information on their subsequent risk of infertility following Chlamydia infection. The British Fertility Society calls for further research to be carried out to estimate the relative risk of subsequent infertility following a Chlamydia infection in women and also to assess whether male fertility improves following treatment for Chlamydia. Chlamydia can be contracted by both men and women and is often a silent infection which may not produce any symptoms. If you are concerned that you may have contracted Chlamydia, we recommend that you visit your GP or local genitourinary medicine clinic."

In addition, the guidelines made several recommendations for good practice in fertility clinics including:

General information

Chlamydia (or Chlamydia trachomatis) is one of the most common sexually transmitted infections worldwide, with an estimated 89 million new cases per year. In 2009, there were 217,570 new Chlamydia diagnoses made in the UK, an increase of 7% from 2008*. Chlamydia infection is most common in under 25 year olds and reported incidence has increased over the past ten years. This may be accounted for by increased testing and more sensitive tests, but may also reflect an increase in risk-taking behaviour.

Chlamydia infections cost the NHS more than £100million per year. Due to this, the NHS in England has set up the National Chlamydia Screening Programme for under 25s (http://www.chlamydiascreening.nhs.uk/).

Notes for editors The guidelines will be published in full in the journal Human Fertility 2010, 13: 115-125. DOI: 10.3109/14647273.2010.513893. (Human Fertility website: http://informahealthcare.com/huf). Human Fertility is the official journal of the British Fertility Society.

For more information: contact the British Fertility Society press office

The British Fertility Society is a national multidisciplinary organisation representing professionals practising in the field of reproductive medicine. The British Fertility Society is committed to promoting good clinical practice and working with patients to provide safe and effective fertility treatment. For general information, see http://www.fertility.org.uk

* Full details available on Health Protection Agency website at http://www.hpa.org.uk/stiannualdatatables

Information for patients
If someone is concerned they may have Chlamydia, they should visit their GP or local genitourinary medicine (GUM) clinic in the first instance. The following resources are also available:

England if under 25 years old
National Chlamydia Screening Programme
Tel: 0800 567 123
Web: http://www.chlamydiascreening.nhs.uk/
Scotland
Sexual Health Scotland
Web: http://www.sexualhealthscotland.co.uk/

ABSTRACT

Impact of Chlamydia trachomatis in the reproductive setting: British Fertility Society Guidelines for Practice

1Bristol Centre for Reproductive Medicine, Southmead Hospital, Bristol, BS10 5NB, UK; 2Department of Reproductive Medicine, Hammersmith Hospital, Imperial College Healthcare Trust, London, W12 0HS, UK; 3Department of Social Medicine, University of Bristol, Canynge Hall, Bristol BS8 2PS, UK; 4Reproductive and Developmental Sciences, University of Edinburgh, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK; 5Academic Unit of Reproductive and Developmental Medicine, School of Medicine and Biomedical Sciences, The University of Sheffield, The Jessop Wing, Sheffield, S10 2SF, UK.

C. trachomatis infections of the genital tract have a worldwide distribution and are the most common sexually transmitted infection. The consequences of infection are known to have an adverse effect on reproductive health of women and are a common cause of infertility. More recent evidence also suggests an adverse effect on male reproduction. There is a need to standardise the approach to managing the impact of C. trachomatis infection on reproductive health. An attempt was also made to survey current UK practice towards screening and management of Chlamydia infections in the fertility setting. We found that at least 90% of clinicians surveyed offered screening. The available literature was examined and we found a paucity of a solid evidence base for estimating the risks of long-term reproductive sequelae following lower genital tract infection with C. trachomatis. The exact mechanism that accounts for the damage that occurs following Chlamydial infections is also uncertain. However, instrumentation of the uterus in women with C. trachomatis infection is associated with a high risk of pelvic inflammatory disease, which can be prevented by appropriate antibiotic treatment. These measures may prevent infected women being at increased risk of the adverse sequelae such as ectopic pregnancy and tubal factor infertility. Recommendations for practice have been proposed and the need for further studies also identified.