Inflammatory and Microbial Biomarker Profiling in Women with Infertility and Subclinical Pelvic Inflammatory Disease
DOI:
https://doi.org/10.53350/Annalspakmed.1.8.03Keywords:
Subclinical PID; infertility; inflammatory biomarkers; microbial biomarkers; IL-6; TNF-α; CRP; PCR; Chlamydia trachomatis; Mycoplasma genitalium.Abstract
Background: Subclinical pelvic inflammatory disease (PID) is a frequent but overlooked contributor to female infertility, particularly in settings where routine screening for asymptomatic genital tract infections is limited. Persistent low-grade inflammation and undetected microbial colonization can lead to endometrial damage, tubal dysfunction, and reduced fertility potential. This study evaluated inflammatory and microbial biomarker profiles in infertile women with subclinical PID compared with infertile women without pelvic inflammation.
Objective: To assess serum inflammatory markers and PCR-based microbial detection in women with infertility and subclinical PID.
Methods: A cross-sectional study was conducted from October 2024 to March 2025 in tertiary care hospitals across Punjab, Pakistan. Ninety women aged 18–40 years presenting with primary or secondary infertility were enrolled. Participants were categorized into a subclinical PID group and a non-PID infertile group based on histological, microbiological, and clinical findings. Serum CRP, IL-6, TNF-α, and ESR were quantified, while PCR was used to detect Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum, Gardnerella vaginalis, and Neisseria gonorrhoeae.
Results: Women with subclinical PID demonstrated significantly elevated CRP, IL-6, TNF-α, and ESR levels. Microbial analysis showed higher detection rates of C. trachomatis, M. genitalium, and G. vaginalis in this group. Strong correlations were observed between inflammatory biomarkers and microbial positivity, particularly IL-6 with C. trachomatis and TNF-α with M. genitalium.
Conclusion: Subclinical PID is associated with a distinct inflammatory and microbial biomarker profile in infertile women. Incorporating biomarker screening and molecular testing into infertility evaluation can facilitate earlier detection, prompt treatment, and prevention of long-term reproductive damage.
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