Quality Of Cervical Mucus Research Articles

A technical note on the Kamranmeter; a manually operated device for measuring salivary spinnbarkeit.

The objective was to develop a manually operatable, non-electric device to measure salivary spinnbarkeit for research, clinical and educational purposes. A newly developed device, named the Kamranmeter, was built and evaluated in a pilot study, comparing the spinnbarkeit of unstimulated and chew-stimulated saliva samples from healthy volunteers. The Neva Meter, which operates on electrical resistance, was used as a reference standard. The study found no statistically significant differences between the two devices when measuring the spinnbarkeit of both unstimulated and stimulated saliva samples from healthy volunteers. We developed a hand-operated device to analyse salivary spinnbarkeit. The Kamranmeter performs comparably to the Neva Meter in measuring spinnbarkeit in saliva obtained from healthy volunteers. The Kamranmeter has potential applications in diagnostic tests involving saliva, such as assessing spinnbarkeit to evaluate conditions like caries and dry mouth. Moreover, it holds promise for broader medical uses, including fertility assessments, where spinnbarkeit is a key indicator of cervical mucus quality. Its ease of handling is expected to make it well-suited for research, clinical, and educational applications.

O-019 Decreased Sperm Motility Associated With Bacterial Vaginosis Modeled in a Human Cervix Chip

Abstract Study question What is the underlying cause of infertility associated with bacterial vaginosis (BV)? Summary answer We provide the first evidence to suggest that BV-associated infertility could be the result of sperm dysfunction induced by exposure to poor cervical microbiome. What is known already Infertility is a global health concern, impacting 186 million individuals worldwide. In 25% of infertile couples the underlying cause remains unexplained. The complex interactions between the host mucosal epithelium, microbiome, and other microenvironmental factors play a significant role in health and disease of the reproductive tract. BV affects 30% of reproductive-aged women and is linked to overgrowth of pathogenic Gardnerella vaginalis bacteria. BV has a strong association with infertility, but it is not clear whether the resulting changes in the vaginal microbiome play a causal role, and as such BV screening is not currently included in infertility evaluation or treatment Study design, size, duration Female reproductive tract protective factors such as cervical mucus helps sperm retain their ability to fertilize for days compared to hours in suspension. We previously leveraged human organ-on-a-chip microfluidic culture technology to develop a physiological in vitro model of human cervix (Cervix Chip) that is lined with primary cervical epithelium interfaced with stromal fibroblasts. The epithelium forms a functional tissue barrier and produces mucus with compositional, biophysical, and hormone-responsive properties similar to the living cervix. Participants/materials, setting, methods We used 2D culture of sperm and bacteria as a screening and validated the effect of the identified bacteria on physiological in vitro Cervix Chip. A BV consortium containing E2 and E4 Gardnerella vaginalis bacteria was co-cultured with the Cervix Chip for 48 hours before adding human sperm samples. The motility of fluorescently labeled sperm was non-invasively evaluated in live chips using time-lapse imaging and quantitatively analyzed to obtain the percentage of motile sperm. Main results and the role of chance We initially analyzed the effects of bacterial co-cultur L. crispatus (optimal) or G. vaginalis (suboptimal) bacteria on sperm motility using a conventional 2D culture system. We observed a significant drop in sperm motility within 2 hours when exposed to G. vaginalis compared to L. crispatus or the control condition (no bacteria). We have established sperm staining and live tracking on Cervix Chip. Motile sperm was tracked on Cervix Chip for more than 7 days compared to 12 hours in suspension. We then tested this effect on-chip and observed that co-culture of live sperm with dysbiotic Cervix Chip (infected with G. vaginalis) resulted in a significant reduction in the sperm motility within 24 hours after exposure compared to the sperm exposed to the chips without bacteria. The dysbiotic Cervix Chip also exhibited a disease phenotype with elevated levels of proinflammatory cytokines including IL-1α, IL-1β, IL-6, IL-8, and TNF-α in the effluents of the chip's epithelial channel as well as significantly reduced thickness of the cervical mucus layer that correlated with reduced sperm motility. This finding is consistent with the observation that successful fertility is often associated with the quality of cervical mucus, which can be compromised in the BV dysbiotic condition. Limitations, reasons for caution Primary cervical epithelium cells used in the study were sourced from a single donor. Frozen sperm samples prepared for intrauterine insemination were used in the study Wider implications of the findings Our study suggests that infertility related to BV may be caused by sperm dysfunction, and BV screening should be considered in patients with unexplained infertility. We propose a model that can be used to identify dysbiotic conditions in the female reproductive tract that are unfavorable to sperm motility. Trial registration number N/A

Randomized controlled phase IIa clinical trial of safety, pharmacokinetics and pharmacodynamics of tenofovir and tenofovir plus levonorgestrel releasing intravaginal rings used by women in Kenya.

Globally, many young women face the overlapping burden of HIV infection and unintended pregnancy. Protection against both may benefit from safe and effective multipurpose prevention technologies. Healthy women ages 18-34 years, not pregnant, seronegative for HIV and hepatitis B surface antigen, not using hormonal contraception, and at low risk for HIV were randomized 2:2:1 to continuous use of a tenofovir/levonorgestrel (TFV/LNG), TFV, or placebo intravaginal ring (IVR). In addition to assessing genital and systemic safety, we determined TFV concentrations in plasma and cervicovaginal fluid (CVF) and LNG levels in serum using tandem liquid chromatography-mass spectrometry. We further evaluated TFV pharmacodynamics (PD) through ex vivo CVF activity against both human immunodeficiency virus (HIV)-1 and herpes simplex virus (HSV)-2, and LNG PD using cervical mucus quality markers and serum progesterone for ovulation inhibition. Among 312 women screened, 27 were randomized to use one of the following IVRs: TFV/LNG (n = 11); TFV-only (n = 11); or placebo (n = 5). Most screening failures were due to vaginal infections. The median days of IVR use was 68 [interquartile range (IQR), 36-90]. Adverse events (AEs) were distributed similarly among the three arms. There were two non-product related AEs graded >2. No visible genital lesions were observed. Steady state geometric mean amount (ssGMA) of vaginal TFV was comparable in the TFV/LNG and TFV IVR groups, 43,988 ng/swab (95% CI, 31,232, 61,954) and 30337 ng/swab (95% CI, 18,152, 50,702), respectively. Plasma TFV steady state geometric mean concentration (ssGMC) was <10 ng/ml for both TFV IVRs. In vitro, CVF anti-HIV-1 activity showed increased HIV inhibition over baseline following TFV-eluting IVR use, from a median of 7.1% to 84.4% in TFV/LNG, 15.0% to 89.5% in TFV-only, and -27.1% to -20.1% in placebo participants. Similarly, anti-HSV-2 activity in CVF increased >50 fold after use of TFV-containing IVRs. LNG serum ssGMC was 241 pg/ml (95% CI 185, 314) with rapid rise after TFV/LNG IVR insertion and decline 24-hours post-removal (586 pg/ml [95% CI 473, 726] and 87 pg/ml [95% CI 64, 119], respectively). TFV/LNG and TFV-only IVRs were safe and well tolerated among Kenyan women. Pharmacokinetics and markers of protection against HIV-1, HSV-2, and unintended pregnancy suggest the potential for clinical efficacy of the multipurpose TFV/LNG IVR. NCT03762382 [https://clinicaltrials.gov/ct2/show/NCT03762382].

Myo-inositol in the treatment of male factor infertility

About 187 million couples worldwide suffer from infertility, with the male factor being diagnosed in 2070% of cases. The main cause of idiopathic infertility has been recognized as the adverse effects of reactive oxygen species. On the one hand, the cellular antioxidant defense is a highly efficient multilevel system; therefore, the pharmacological targets may vary. On the other hand, antioxidant enzymes (superoxide dismutase, catalase, peroxidase) have high activity and specificity, which limits the pharmacological capabilities of direct antioxidants. Indirect methods, such as the normalization of mitochondrial function, are more promising. Mitochondria play a key role in providing energy for sperm motility (one of the main factors of male fertility). Myo-inositol (MI) derivatives involved in cell signaling regulate intracellular Ca2+ ion levels affecting mitochondrial oxidative metabolism and adenosine triphosphate production. Thus, mitochondrial antioxidants are of particular interest for therapeutic strategies. Currently, various routes and regimens of MI use in the treatment of males with oligo-astheno-teratozoospermia (OAT) are being considered in clinical practice. MI-based oral nutraceutical complexes for the treatment of male factor infertility contain both direct and indirect antioxidants. In vitro studies revealed damage to mitochondrial cristae in the sperm intermediate tract in patients with OAT. Experimental studies have demonstrated that mitochondrial structure is restored when sperm are incubated in an MI-containing medium. Clinical studies confirmed that sperm incubation in such an environment leads to increased sperm motility and viability in patients with OAT. Intravaginal administration of MI showed increased total sperm motility and an increased proportion of progressively motile sperm. It is the progressive motility that is considered the best marker for identifying quality and healthy sperm. This type of sperm is usually used for in vitro fertilization techniques. In addition, intravaginal MI administration improved the quality of cervical mucus and reduced its viscosity and crystallization. The effect of intravaginal MI on cervical mucus can be considered as an additional independent factor in increasing fertility.

Cervical mucus patterns and the fertile window in women without known subfertility: a pooled analysis of three cohorts.

STUDY QUESTION What is the normal range of cervical mucus patterns and number of days with high or moderate day-specific probability of pregnancy (if intercourse occurs on a specific day) based on cervical mucus secretion, in women without known subfertility, and how are these patterns related to parity and age? SUMMARY ANSWER The mean days of peak type (estrogenic) mucus per cycle was 6.4, the mean number of potentially fertile days was 12.1; parous versus nulliparous, and younger nulliparous ( 3 days (exceeded by 72% of women), most minus fewest days of non-peak type mucus >4 days (exceeded by 54% of women), greatest minus least cervical mucus cycle score >4.0 (exceeded by 73% of women), and most minus fewest potentially fertile days >8 days (found in 50% of women). Race did not have any association with cervical mucus parameters. Recent oral contraceptive use was associated with reduced cervical mucus cycle score and partial breast feeding was associated with a higher number of days of mucus (both peak type and non-peak type), consistent with prior research. Among the women for whom data were available (CEIBA and TTP), alcohol and tobacco use had minimal impact on cervical mucus parameters. LIMITATIONS, REASONS FOR CAUTION We did not have data on some factors that may impact ovulation, hormone levels, and mucus secretion, such as physical activity and body mass index. We cannot exclude the possibility that some women had unknown subfertility or undiagnosed gynecologic disorders. Only 27 women were age 35 or older. Our study participants were geographically dispersed but relatively homogeneous with regard to race, ethnicity, income, and educational level, which may limit the generalizability of the findings. WIDER IMPLICATIONS OF THE FINDINGS Patterns of cervical mucus secretion observed by women are an indicator of fecundity and the fertile window that are consistent with the known associations of age and parity with fecundity. The number of potentially fertile days (12 days) is likely greater than commonly assumed, while the number of days of highly estrogenic mucus (and higher probability of pregnancy) correlates with prior identifications of the fertile window (6 days). There may be substantial variability in fecundability between cycles for the same woman. Future work can use cervical mucus secretion as an indicator of fecundity and should investigate the distribution of similar cycle parameters in women with various reproductive or gynecologic pathologies. STUDY FUNDING/COMPETING INTEREST(S) Funding for the three cohorts analyzed was provided by the Robert Wood Johnson Foundation (CMFS), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (TTP), and the Office of Family Planning, Office of Population Affairs, Health and Human Services (CEIBA). The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A.

Myo-inositol impact on sperm motility in vagina and evaluation of its effects on foetal development.

To counteract the arising problem of couple infertility, having good quality gametes is increasingly important. A molecule that seems to be useful to favor this condition is myo-inositol (MI), the most common stereoisomer of the inositol family, involved as second messenger in several cell pathways (osmoregulation, chromatin remodeling, gene expression, etc.). To evaluate this possibility, a treatment with myo-inositol in idiopathic infertile couples was performed in this randomized, placebo-controlled study. 86 couples were enrolled and randomly assigned to two groups, treated either with MI (Xyminal®, Lo.Li. Pharma Srl, Rome, Italy) or placebo suppositories, to evaluate the effects on sperm motility, cervical mucus quality and pregnancy rate. Moreover, in pregnancy cases, all routine controls on gestation progress and foetal health were performed to confirm the safety of this treatment. As showed in this study, MI treatment allows an increase of total sperm motility (54.42 ± 8.72) in comparison to placebo group (46.21 ± 5.33). Moreover, MI mildly improves cervical mucus quality and increases the number of pregnancies (18.60%) in comparison to the placebo group (6.97%). MI improves sperm motility and cervical mucus quality, increasing the probability of conception. The absence of adverse events both for the mother and the foetus confirmed the safety of this molecule in pregnancy, supporting even more its use for couples seeking pregnancy.

Prevalence of anti-sperm antibodies and relationship of degree of sperm auto-immunization to semen parameters and post-coital test outcome: a retrospective analysis of over 10 000 men.

What is the prevalence and the relationship of anti-sperm antibodies (ASA), screened by means of IgG-mixed anti-globulin reaction (MAR) test, to semen quality and post-coital test (PCT) outcome? A 100% positive IgG-MAR test, detected in 2% of the study population, was associated with lower sperm output and progressive motility, and was the sole determinant of higher prevalence of a negative PCT outcome. Although ASA may affect sperm fertilizing ability and the IgG-MAR test is recommended by the World Health Organization (WHO) as an integral part of semen analysis for screening the occurrence of ASA, the prevalence and clinical relevance of positive MAR test results remain controversial. A retrospective analysis of 12 296 consecutive men who attended a university/hospital andrology clinic for the evaluation of fertility potential was carried out. Immunological screening with the IgG-MAR test was performed on all ejaculates as an integral part of semen analysis. Positive samples (≥10%) were further tested for IgA-ASA. The prevalence of positive IgG-MAR tests results, along with the relationship of the degree of sperm auto-immunization to semen parameters and PCT outcome, were analyzed. After excluding semen samples showing azoospermia or severe oligo-asthenozoospermia, the prevalence of a positive IgG-MAR test in the remaining 10 025 men was 4%, 3.4% and 2%, with 10%, 50% and 100% thresholds, respectively. The 100%-positive MAR tests exhibited significantly higher consistency over time, and were significantly associated with higher prevalence of a mixed pattern (i.e. when the majority of sperm exhibited beads attached on both the head and along the tail) of positivity as well as with the concomitant occurrence of IgA-ASA. Additionally, the 100%-positive MAR tests were significantly associated with a lower median value of the total number of spermatozoa and progressive motility, compared to samples with a lower degree of positivity or negative samples. In the PCT performed in 120 couples, where ASA were detected in the male partner, the 100%-positive MAR tests were significantly associated with a higher prevalence of negative PCT outcome, in comparison to the lower degree of positivity, independent of, and without any significant contribution from, other determinants (semen and cervical mucus quality). Only surrogate infertility-related end-points were analyzed in the present study. However, since the impairment of sperm penetration through the cervical mucus represents the primary mechanism of ASA-interference with fertility, PCT outcome may represent a suitable clinical end-point. The present study, being the largest reported to date, provides a reliable estimate of ASA prevalence. Moreover, it indicates that a 50%-positive MAR test, which is suggested by WHO as the clinically-relevant threshold, also includes patients with a degree of sperm auto-immunization that contributes to couple infertility only in the presence of other causal factors; conversely, the 100%-positive MAR test can represent the sole determinant of couple infertility, as it was the sole significant predictor of the highly prevalent negative PCT outcome. The study was supported by the University of L'Aquila, Italy. The authors declare no competing interests. N/A.

Comparative Study between Effect of Clomiphene Citrate, Tamoxifen and Letrozole on Endometrial Thickness in Induction of Ovulation in Patient with Polycystic Ovarian Syndrome

Background: Infertility is the inability of a married couple to conceive within one year in spite of regular marital life. Globally 10-15% of the married couples are experiencing this problem. CC is non-steroidal selective estrogen receptor modulator (SERM), has both estrogen agonist and antagonist properties. It binds to estrogen receptors primarily in the hypothalamus, which interrupts the negative feedback of the increasing estrogen level and results in continued production of FSH, which stimulates follicular growth and maturation. Its anti-estrogenic effect causes long standing estrogen receptor depletion due to its long half life (2 weeks), so it has adverse effects on the quality and quantity of cervical mucus and negative impact on endometrial development causing its thinning, implantation failure and decreased blood flow during the peri-implantation stage. Objectives: The aim of the study is to compare the effect of the following 3 drugs during induction of ovulation: 1- Clomiphene citrate, 2- Tamoxifen, 3- Letrozole. Patients and Methods: This study was carried out in El Entag El Harby Hospital. The patients were recruited from the Infertility outpatient clinic between December 2017 and June 2018. This prospective study included 150 infertile women who were diagnosed as anovulatory infertility and meet the inclusion criteria. This study followed the ethical committee rules of Obstetrics & Gynecology department, Al Azhar University. For all women with anovulatory infertility in this study; explanation of the study procedures was done to all women sharing in the study and informed written consents were obtained. In the current study, patients were divided into three groups, each group formed of 50 patients: Group 1 (CC), Group 2 (letrozole), Group 3 (TMX). First of all, the groups in our study were matched as regard to age, BMI, type and duration of infertility. Results: The current study shows a statistically significant difference between the three groups regarding the endometrial thickness, which was significantly thinner in group 1 (CC) than the other two groups; group 2 (letrozole) and group 3. Conclusion: Clomiphene citrate has a negative effect on endometrial thickness which is mostly attributed to its antiestrogenic effect. A triple layered endometrium (trilaminar pattern) is associated with higher pregnancy rates; therefore, patients receiving CC with non trilaminar pattern have reduced pregnancy rates.

Comparative Study between Effect of Clomiphene Citrate, Tamoxifen and Letrozole on Endometrial Thickness in Induction of Ovulation in Patient with Polycystic Ovarian Syndrome

Background: Infertility is the inability of a married couple to conceive within one year in spite of regular marital life. Globally 10-15% of the married couples are experiencing this problem. CC is non-steroidal selective estrogen receptor modulator (SERM), has both estrogen agonist and antagonist properties. It binds to estrogen receptors primarily in the hypothalamus, which interrupts the negative feedback of the increasing estrogen level and results in continued production of FSH, which stimulates follicular growth and maturation. Its anti-estrogenic effect causes long standing estrogen receptor depletion due to its long half life (2 weeks), so it has adverse effects on the quality and quantity of cervical mucus and negative impact on endometrial development causing its thinning, implantation failure and decreased blood flow during the peri-implantation stage. Objectives: The aim of the study is to compare the effect of the following 3 drugs during induction of ovulation: 1- Clomiphene citrate, 2- Tamoxifen, 3- Letrozole. Patients and Methods: This study was carried out in El Entag El Harby Hospital. The patients were recruited from the Infertility outpatient clinic between December 2017 and June 2018. This prospective study included 150 infertile women who were diagnosed as anovulatory infertility and meet the inclusion criteria. This study followed the ethical committee rules of Obstetrics & Gynecology department, Al Azhar University. For all women with anovulatory infertility in this study; explanation of the study procedures was done to all women sharing in the study and informed written consents were obtained. In the current study, patients were divided into three groups, each group formed of 50 patients: Group 1 (CC), Group 2 (letrozole), Group 3 (TMX). First of all, the groups in our study were matched as regard to age, BMI, type and duration of infertility. Results: The current study shows a statistically significant difference between the three groups regarding the endometrial thickness, which was significantly thinner in group 1 (CC) than the other two groups; group 2 (letrozole) and group 3. Conclusion: Clomiphene citrate has a negative effect on endometrial thickness which is mostly attributed to its antiestrogenic effect. A triple layered endometrium (trilaminar pattern) is associated with higher pregnancy rates; therefore, patients receiving CC with non trilaminar pattern have reduced pregnancy rates.

Assessment of the quality of cervical mucus among users of the levonorgestrel-releasing intrauterine system at different times of use

Background and objectives: The quality of cervical mucus (CM) among the levonorgestrel-releasing intrauterine system (LNG-IUS) users is controversial. The objectives were to assess CM compared to the levels of oestradiol (E2) and the frequency of cycles with luteal activity among users of the LNG-IUS.Materials and methods: In total, 224 LNG-IUS users for between two months and five years were recruited at a Brazilian family planning clinic. For the cross-sectional part of the study, we enrolled 175 LNG-IUS users at 2, 6 12, 24, 36, 48, and 60 months after insertion (25 women in each group), and we performed one evaluation. For the prospective part of the study, we enrolled 49 LNG-IUS users at the same lengths of use after insertion (7 women in each group), and we evaluated these women once a week for five consecutive weeks. .Results: Mean (± SEM) CM scores of all evaluations among women with single and weekly evaluations were between 3.3 ± 0.9 and 8.5 ± 0.3, respectively independently of the length of use of the LNG-IUS. Mean E2 values ranged from 45.5 ± 6.8 to 472.5 ± 34.7 pg/ml and the maximum ovarian follicle diameter on the days of evaluation varied from 14.0 ± 1.3 to 31.2 ± 0.4 mm.Conclusions: The mean CM score of all evaluations, independent of the length of use of the LNG-IUS and normal levels of serum E2, was below 10 was according to the WHO is inadequate for sperm penetration.

Pathways regulating the nonhuman primate cervix

Mucus secretion plays a crucial role in the passage of sperm through the primate cervix. Estrogens and progestins affect cervical mucus secretion and quality (1,2), but the molecular pathways mediating the effects of ovarian steroids on the cervix are poorly understood. Macaques are excellent primate animal models for studies that involve invasive procedures. The aim of this study was to identify hormonally regulated genes and their related biological pathways in the macaque cervix during the menstrual cycle.

Serum levonorgestrel concentration and cervical mucus viscosity after six months of monoplant® implantation

Background: The use of levonorgestrel implants as a contraceptive method have undergone changes in the number of implants used, beginning from six rods in the early methods to two rods in the present method and have been proven effective. This study aims to evaluate the efficacy of single rod implant (Monoplant®) by measuring serum levonorgestrel concentration and cervical mucus quality. Methods: Thirty healthy women, aged 20-40 year old, and have been proven fertile, underwent single rod implant insertion. Levonorgestrel serum levels was measured every month and cervical mucus viscosity was examined every three month, until six months. Results: Levonorgestrel serum concentration was consistently above minimum effective level (200 pg/mL), from month 3 to 6 respectively 338.9 pg/mL, 424.8 pg/mL, 320.3 pg/mL, and 337.5 pg/mL. Almost all of the acceptors (96.7%) had good cervical mucus viscosity since three months following implant insertion. Conclusion: Levonorgestrel serum concentration in Monoplant® users was still above minimum contraceptive level until the sixth month. Viscosity of cervical mucus increased immediately following implant insertion. This indicates that single rod levonorgestrel implant is effective as a contraceptive method. Keywords: cervical mucus viscosity, implant monoplant®, serum levonorgestrel

Comparison of cervical mucus of 24/4 vs. 21/7 combined oral contraceptives

BackgroundFew studies have examined the action of combined oral contraceptives (COCs) on cervical mucus. We hypothesized that midcycle cervical mucus of women taking COCs is of poor quality when compared to their own midcycle mucus prior to initiating COCs. We sought to compare the effect upon quality and sperm penetration of the cervical mucus on the last hormone-free day with a 24/4 regimen to a 21/7 regimen. MethodsThis is an open-label, investigator-blinded, randomized, controlled, crossover equivalency study. All subjects received, in random order, 2 months of a 21/7 regimen and 2 months of a 24/4 regimen, each containing 20 mcg ethinyl estradiol and 1 mg norethindrone acetate. Analysis of cervical mucus quality (CMQ) and sperm penetration took place midcycle and on the last day of the hormone-free interval during the second month of each COC treatment. ResultsFrom April 2010 to November 2011, 18 subjects completed all study visits. Mean midcycle CMQ was poor (mean CMQ=1) and did not differ between 24/4 and 21/7 regimens (p=.92). On the last day of the pill-free interval, the quality and sperm penetration were poor with both regimens. ConclusionThis study indicates that thickening of cervical mucus is a major mechanism of contraceptive action of COCs and that both 21/7 and 24/4 regimens result in poor quality and impenetrable mucus on the last day of the pill-free interval.

Presence of DNA of adeno-associated virus in subfertile couples, but no association with fertility factors

Based on previous reports suggesting a role of adeno-associated virus (AAV) in miscarriage, the prevalence of AAV DNA in genital tracts of male and female partners of subfertile couples was determined to assess a potential association of AAV infection with clinically relevant parameters of male and female fertility. A prospective study was performed in the outpatient infertility clinic of a university-based hospital. Semen samples and endocervical material obtained from 146 male and 134 female partners of asymptomatic subfertile couples were analyzed for the presence of AAV DNA (using nested PCR). Patients' medical histories and details of clinical examinations were recorded. Semen quality, including sperm functional capacity and the presence of antisperm antibodies (ASA) and seminal white blood cells (WBC), was assessed in aliquots of the same ejaculate. Detailed examinations of the cervical factor and other variables of female subfertility were performed. Both partners were screened for bacterial infection. The presence of AAV DNA in semen was not significantly related to semen quality, including sperm functional capacity or local ASA, nor was it coupled to the presence of AAV in the endocervical material of female partners. The presence of AAV DNA was not associated with the presence of other micro-organisms of the lower genital tract or with seminal WBC in men. AAV DNA in endocervical material was not related to a reduced quality of cervical mucus or to other female infertility factors. The presence of AAV DNA in semen samples or endocervical swabs showed no significant association with clinically relevant infertility factors. However, longitudinal studies may clarify previous suggestions of an influence of AAV infection on early pregnancy problems.

Characteristics of the Menstrual Cycle After Discontinuation of Oral Contraceptives

Menstrual cycle function may continue to be altered after discontinuation of oral contraceptives (OC). Few studies have been published on the effects of recent OC use on menstrual cycle parameters; none have examined characteristics of the menstrual flow or the quality of cervical mucus. The purpose of this retrospective matched cohort study is to assess biomarkers of the menstrual cycle after discontinuation of OCs. Among a sample of women who daily recorded observations of menstrual cycle biomarkers, 70 women who had recently discontinued OCs were randomly matched by age and parity with 70 women who had not used OCs for at least 1 year. Outcomes investigated included overall cycle length, length of the luteal phase, estimated day of ovulation, duration of menstrual flow, menstrual intensity, and mucus score. Differences between recent OC users and controls were assessed using random effects modeling. Recent OC users had statistically significantly lower scores for mucus quality for cycles 1 and 2. Additionally, OC users had a later estimated day of ovulation that was statistically significant in cycle 2 and a decreased intensity of menstrual flow that was significant in the first four cycles (difference = -0.48 days). In random effects modeling, all these parameters were significantly different for the first six cycles combined. Menstrual cycle biomarkers are altered for at least two cycles after discontinuation of OCs, and this may help explain the temporary decrease in fecundity associated with recent OC use.

Anti-Helicobacter pylori antibodies in cervical mucus: a new cause of infertility

ObjectiveThe aims of our study were to determine on the one hand a correlation between the presence of anti-Helicobacter pylori (anti-H. pylori) IgG antibodies in serum and cervical mucus of women with idiopathic infertility, and on the other hand the effect of these antibodies on cervical mucus quality, in particular related to the ability of spermatozoa to penetrate it. Study designWe analysed anti-H. pylori IgG antibodies in the serum and cervical mucus of 67 patients diagnosed with idiopathic infertility using the Quanta Lite H. pylori IgG test. The penetration of normal sperm, in 15 cervical mucus samples positive for anti-H. pylori antibodies and in 15 negative samples, was assessed using the simplified slide test. ResultsA significant positive correlation emerged between anti-H. pylori IgG antibody concentrations in the serum and in the cervical mucus (r=0.9275; p<0.00001). In the 15 anti-H. pylori IgG mucus-positive samples the slide test showed abnormal penetration by the spermatozoa. ConclusionsOur study demonstrated that the presence of anti-H. pylori antibody in the cervical mucus can be involved in female infertility, interfering with sperm progression. Considering the close correlation found between serum and cervical mucus anti-H. pylori antibody titres, measuring serum antibodies could become an additional test, in particular in couples with unexplained infertility.

Length of time after insertion of the levonorgestrel-releasing intrauterine system for it to significantly alter cervical mucus quality and sperm penetration

OBJECTIVE: To compare the qualities of cervical mucus (CM) and three parameters of sperm penetration in CM of subjects prior to insertion of levonorgestrel-releasing intrauterine system (LNG-IUS) and at 1, 3 and 5 days after insertion using WHO cervical mucus grading criteria and an in-vitro sperm penetration test (SCMPT). DESIGN: Clinically descriptive. MATERIALS AND METHODS: Twenty-five ovulatory women who desire LNG-IUS for contraception are being enrolled for participation in this study. LNG-IUS is inserted when the cervical mucus grading score (CMGS) first reaches 10. CM evaluation and in-vitro SCMPT are performed just prior to LNG-IUS insertion and on post-insertion days 1, 3 and 5. RESULTS: To date six women have completed the study. The LNG-IUS was inserted on cycle day 10 in one subject, day 12 in four subjects and day 14 in one subject when all subjects' CM was of good quality and had good sperm penetration meter scores (SPMS). There were significant decreases in the median SPMS and median CMGS among CM samples obtained just prior to LNG-IUS placement, and those obtained days 1, 3 and 5 after insertion. CONCLUSION: When the LNG-IUS was inserted at the time of maximum CM production, CM was of poor quality with poor sperm penetration by day 1 after insertion of LNG-IUS in 5 of 6 subjects and by day 3 in all six subjects and remained poor during post-insertion day 5. It appears the LNG-IUS becomes contraceptively effective 3 days after insertion, possibly earlier, however, more subjects are needed to clarify this issue. These preliminary data suggest back up contraception is not needed for more than 3 days after LNG-IUS insertion.

Effects of the levonorgestrel-releasing intrauterine system on cervical mucus quality and sperm penetrability

Background In levonorgestrel intrauterine system (LNG-IUS) users, the prevention of sperm penetration through cervical mucus has not been demonstrated. Study Design Subjects were enrolled in an investigator-blinded study to compare quality and sperm penetrability of mid-cycle cervical mucus between LNG-IUS users and hormone-free controls. Cervical mucus was microscopically examined using World Health Organization (WHO) cervical mucus analysis (CMA). CMA score ≥10 of 15 points indicated cervical mucus favoring sperm penetration. Mucus was incubated with sperm using the WHO simplified slide test (SST) and Kremer sperm cervical mucus penetration test (SCMPT). Results Data from 14 LNG-IUS users and 16 controls showed 14% of LNG-IUS users had CMA score ≥10% vs. 69% of controls (p=.004). SST showed no sperm penetration for LNG-IUS users, significantly less than controls (0% vs. 64.3%, p<.001). SCMPT demonstrated no sperm mucus penetration for LNG-IUS users at 2 and 6 h (0% vs. 85% in controls with 2-h score ≥6, p<.001; 6 h 0% vs. 79% in controls, p<.001). Conclusions Mid-cycle cervical mucus of LNG-IUS users is poor quality and prevents endocervical sperm transport in vitro.

Length of time after insertion for the levonorgestrel-releasing intrauterine system for it to significantly alter cervical mucus quality and sperm penetrability

Length of time after insertion for the levonorgestrel-releasing intrauterine system for it to significantly alter cervical mucus quality and sperm penetrability

Nitric oxide donors increases pregnancy rate in clomiphene citrate treated polycystic ovary infertile patients

Abstract Objectives To test if treatment of polycystic ovary (PCO) infertile patients with clomiphene citrate (CC) and the nitric oxide (NO) donors isosobid mononitrate (ISMN) might improve the ovulation and pregnancy rates compared to treatment with CC alone. Study design Prospective, randomized, controlled study. Setting Benha university hospital. January 2008 to January 2009. Subjects and methods The study included thirty PCO infertile patients divided randomly into a control and a study groups each fifteen cases. Patients in the control group were treated with 100mg CC for five days starting from the fifth day of the cycle. The study group received in addition to CC, 20mg ISMN tablet applied vaginally till the diagnosis of ovulation and pregnancy. Primary outcome measures Ovulation and pregnancy rate in the CC+ISMN group compared to the CC alone group. Secondary outcome measures Number of mature follicles (⩾18mm), cervical mucus score and endometrial thickness in both groups. Results There was a significant increase in the ovulation and pregnancy rates in the CC+ISMN group. The number of mature follicles, the cervical mucus score and the endometrial thickness were significantly higher in this group. Conclusions This novel treatment of infertile PCO patients with combination of CC and NO donors is simple and promising. The ovulation and pregnancy rates are increased due to improvement of follicular maturation, cervical mucus quality and endometrial receptivity.