Worldwide Prevalence of Chlamydia trachomatis in Infertile Women: A Systematic Review and Meta-analysis

Chlamydia trachomatis ( CT ) infection is a prevalent sexually transmitted disease (STD). It seems that CT infections ascending to the uterus can result in serious reproductive health complications, including infertility. Therefore, this systematic review and meta-analysis was conducted to assess the worldwide prevalence of CT among infertile women. A systematic search was conducted across three major databases, Medline (via PubMed), Web of Science, and Scopus, to identify eligible studies between 2010 and July 2025. Keywords such as " Chlamydia trachomatis ," "infertility," "women,” and "prevalence “were used. The prevalence of CT among infertile women was estimated using random-effects model meta-analyses and reported with 95% confidence intervals (CIs). Subgroup analyses were conducted based on detection method and sample type. Meta-regression analysis was performed to evaluate the relationship between CT prevalence and either participants' age or year of publication. Thirty-eight studies, involving 14995 infertile women, were included in this study. The overall pooled prevalence of CT among infertile women was 24.1% (95% CI: 17.1–33.00). Regarding the diagnostic sample type, the highest prevalence of CT was observed in blood samples 45.7% (95% CI: 34.7–57.2), whereas the lowest was found in urine sample 10.8% (95% CI: 7.2–15.9). In terms of detection method, the highest prevalence of CT was reported using ELISA 26.9% (95% CI: 14.4–44.5), whereas the lowest prevalence was observed with the rapid test kit 7.9% (95% CI: 4–1.27). In endocervical samples, real-time PCR showed the highest prevalence among detection methods 20.5% (95% CI: 11.8–33.3) compared with other methods, indicating its high diagnostic sensitivity. This finding indicates that the overall prevalence of CT among infertile women is relatively high, highlighting the importance of paying special attention to this pathogen in infertility assessments. Among diagnostic methods, ELISA showed the highest overall prevalence, while real-time PCR in endocervical samples demonstrated high diagnostic sensitivity, emphasizing its effectiveness for accurate detection in this sample type. Ultimately, routine and standardized CT screening in infertile women may facilitate early detection, timely intervention, and improved fertility outcomes.