Endocervical Mucus Research Articles

Significant Increase in Pregnancy Rate Achieved by Vigorous Irrigation of Endocervical Mucus Prior to Embryo Transfer With the Wallace Catheter in an IVF-ET Program

Significant Increase in Pregnancy Rate Achieved by Vigorous Irrigation of Endocervical Mucus Prior to Embryo Transfer With the Wallace Catheter in an IVF-ET Program

Chlamydial serology in 1303 asymptomatic subfertile couples.

The clinical significance of antichlamydial antibodies (Chlam Ab) was determined in a total of 1303 subfertile couples consulting for infertility investigation and treatment. Median age of the women was 30 (range 22-44) years and of the men 33 (range 21-53) years. The median duration of infertility was 4 (range 1-21) years. All patients were asymptomatic for genital tract infection. A comprehensive infertility investigation included examination of the endocrine, cervical, and tubal factor, and semen analysis, antisperm antibody (ASA) testing, sperm-mucus interaction testing in vitro using a standardized protocol, and post-coital testing (PCT). Screening for Chlam IgG Ab was performed in serum of both partners, obtained at the same time. Simultaneous microbial cultures in genital secretions of both partners included a broad spectrum of potentially pathogenic bacteria. Elevated titres of Chlam IgG Ab as seromarker for previous infection were found in 20.8% of all women, and in 12.6% of men. Chlam Ab were significantly more frequent in partners of seropositive patients (in 51.8% of women with a Chlam Ab positive partner, compared to 15.8% of the other women). Microbial screening outcome was not significantly related to results of chlamydial serology in both partners. In women, elevated titres of Chlam Ab were significantly associated with a tubal factor, but were not related to reduced quality of the endocervical mucus (CM), including the in-vitro penetrability of the CM (using partners' or donors' spermatozoa). In males, Chlam Ab were not significantly related to the outcome of semen analysis, including screening for ASA (IgG and/or IgA) in semen, and several parameters of sperm functional capacity. After exclusion of couples with tubal disease, subsequent male fertility did not significantly differ in males with or without Chlam Ab. The results suggest that during basic infertility investigation, positive chlamydial serology as an easy screening procedure indicates a higher risk for a tubal infertility factor. However, in asymptomatic patients, Chlam IgG Ab in serum are not associated with a cervical factor or with the male factor, using several determinants for evaluation of semen quality including subsequent fertilizing capacity.

P-243 Significant increase in pregnancy rate achieved by vigorous irrigation of endocervical mucus prior to embryo transfer with the wallace catheter in an IVF-ET program

P-243 Significant increase in pregnancy rate achieved by vigorous irrigation of endocervical mucus prior to embryo transfer with the wallace catheter in an IVF-ET program

Influence of smear quality on the rate of detecting significant cervical cytologic abnormalities.

To determine the correlation between cervical smear quality and the rate of detecting significant epithelial abnormalities. Smear quality was assessed routinely in a series of 68,328 cervical spatula and spatula/brush combination smears received by our laboratory during 1993. Quality was assessed using a semiquantitative method, evaluating the presence of endocervical cells, metaplastic squamous cells, endocervical mucus and overall squamous cellularity. Smear quality was graded as unsatisfactory, poor (18,680 smears), fair (9,739 smears) or good (39,909 smears); unsatisfactory smears were eliminated from the analysis. There was a highly significant correlation between smear quality and the rate of detecting significant epithelial abnormalities (chi 2=127.52, df=2, P<.001). Smear quality is an important issue. Many significant abnormalities are potentially missed because of poor smear quality.

Endocervical mucus pH is inversely related to serum androgen levels and waist to hip ratio

To determine whether an inter-relationship exists between endocervical mucus pH, serum androgen levels, and waist to hip (W:H) ratio. Donor insemination clinic, University of Sheffield, Jessop Hospital, Sheffield, United Kingdom. One hundred patients receiving donor insemination. Waist, hip, height, and weight measurements were recorded for 100 patients receiving donor insemination. At the onset of the LH surge when patients attended for their first insemination, a sample of endocervical mucus and blood was taken. The Insler score of the mucus was recorded and the pH was measured with multirange pH paper. Of the 100 patients studied, 10 cases had an endocervical mucus pH < 6 despite Insler scores of > 10. Serum T, DHEAS, and androstenedione levels were measured in the 10 patients with pH < 6 and in 26 patients selected at random from the 90 patients with pH > or = 6. The W:H ratio was significantly higher in the patients with pH < 6 than pH > or = 6. No significant difference was seen in body mass index between the latter groups. All serum androgen levels were significantly higher in the patients with pH < 6 than pH > or = 7. A potential link (serum androgen levels) between a powerful predictive factor of fertility (W:H ratio) and a potential mechanism of subfertility (low endocervical mucus pH) has been demonstrated. This observation warrants further detailed evaluation particularly as it has been shown that a low endocervical mucus pH may be corrected by simple inexpensive treatment.

Actinomyces-Like Organisms in Women Using Intrauterine Contraceptive Devices (IUCD)

Actinomyces-Like Organisms in Women Using Intrauterine Contraceptive Devices (IUCD)

The pH as an important determinant of sperm-mucus interaction

To determine the clinical significance of endocervical mucus pH on sperm-mucus interaction during infertility investigation. Two hundred sixteen couples with a median duration of infertility of 4 years (range, 1 to 19 years) presenting at the infertility unit of the Women's University Hospital of Heidelberg, Germany. Determination of endocervical pH by colorimetric and electrometric measurement and correlation of results with the outcome of postcoital testing (PCT) and other parameters of infertility investigation (semen and cervical mucus [CM] quality, microbial colonization of cervix and ejaculates, medical history, hormonal status, and specific medication) and the subsequent fertility in a prospective study. In vitro experiments with the sperm-cervical mucus penetration test (SCMPT) used as biological model. The colorimetric determination of endocervical mucus pH is an easy method, suitable for routine clinical use, correlating significantly with electrometric measurement of pH. Median pH was 7.0 (range, 5.4 to 8.2). The mucus pH was significantly related with the results of PCT, even when mucus and semen variables were taken into account. No significant relationship was seen between the cervical index and mucus pH and the microbial colonization of cervix and ejaculates. The pH of endocervical secretions correlated with the peripheral hormonal status: low pH levels were significantly more frequent in patients with hyperandrogenemia, indicated by high testosterone and/or dehydroepiandrosterone sulfate levels before medication was started, and in hyperandrogenemic patients treated with dexamethasone than in the other women. Oral administration of estrogens led to a subtle alkalinization of the CM. With regard to subsequent fertility 6 months after pH testing, the pregnancy rate was significantly lower in women offering reduced mucus pH on occasion of the PCT in the group of couples with primary infertility and in couples with oligozoospermia of the male partner. The significant influence of pH on sperm-mucus interaction was confirmed in vitro with the SCMPT. The results indicate that the pH of the CM, easily determined with pH indicator paper, is an important parameter of mucus quality with significant influence on spermatozoal viability in CM, which correlates with peripheral hormonal status and can be affected by oral medication with estrogens. Therefore the routine determination of pH on occasion of the PCT is recommended during infertility investigation.

The prevalence of ureaplasma, mycoplasma and antibodies against chlamydia group antigen in gynecological outpatients.

177 women with an average age of 30 years were investigated for ureaplasma, mycoplasma and for antibodies against the chlamydia group antigen. Specimen of endocervical mucus and catheter specimens of urine were cultured and the ELISA ("enzyme-linked immunosorbent assay") technique applied. In addition the purity class (I to III) of gram-stained vaginal smears was determined. Ureaplasma were isolated from 45.8 and 26.0%, mycoplasma from 9.0 and 7.9% of cervical and urine specimens respectively. The patients were divided into 5 clinical groups. Patients in the first three groups (I-III, inflammatory disorders, bleeding anomalies, benign and malignant neoplasms of the genital tract) showed a significantly (p less than or equal to 0.05) higher colony count of ureaplasma in their urine than patients in the other two groups (IV and V, who had attended the hospital for reproductive problems or for routine examination). There was a clear correlation between the isolation rates of ureaplasma and mycoplasma and the purity classes of the vaginal smears. The rate of isolation increased progressively with class II and III smears. Antibodies against the chlamydia group antigen were detected in about 40% of all sera tested. A very high titer of antibodies reflecting a recent chlamydial infection was found in 11% of the sera tested.

Treatment of infertile women with a deficient postcoital test with two antiestrogens: clomiphene and tamoxifen

Twenty-two infertile women with repeated deficient results in the postcoital test received clomiphene citrate or tamoxifen. The patterns of luteinizing hormone, follicle-stimulating hormone, prolactin, 17 beta-estradiol (E2), and progesterone were examined during the follicular and periovulatory phases of the menstrual cycle, as were the cervical mucus characteristics. Under clomiphene treatment, an overproduction of E2 was observed (P less than 0.01), which did not result in an improvement of the cervical mucus characteristics. The pH of the endocervical mucus was lower (P less than 0.01). Under tamoxifen treatment, the serum E2 levels were higher (P less than 0.05) and normalized. Higher spermatozoa penetration meter scores were observed during the preovulatory and periovulatory periods, whereas the pH of the endocervical mucus was not lowered. These data support that tamoxifen may be preferential to clomiphene in treating this kind of infertile woman.

The effect of estrogen and gestagen on the mucus production of human endocervical cells: a histochemical study

The effect of hormonal stimulation on the intracellular mucus production of the endocervical cells was histochemically and morphometrically investigated. Twenty-seven cervixes from patients who had received estrogen or gestagen prior to hysterectomy were examined. "Upper" versus "lower" cervix and "small" versus "large" crypts were compared in both groups of patients. The histochemical analysis of mucins within the cells was based mainly on the combined alcian blue/periodic acid Schiff (AB/PAS) techniques at various pH levels. A semiquantitative estimation using cell counts and statistical evaluations was done for each staining method. The results indicate that sex hormones influence the chemical composition of endocervical mucus production. In addition, the nature of the intracellular mucus varies with the cryptal size and location within the cervical canal.

Prognostic value of the postcoital test: prospective study based on time-specific conception rates.

Time-specific conception rates were studied prospectively after a carefully validated post-coital test (PCT) in a consecutive series of 80 ovulatory women without any pelvic or seminal cause for their previous infertility. The PCT was performed on endocervical mucus collected 6-18 h after intercourse. The definition of a negative result, indicated by the absence of forward-moving sperm, depended on the finding being repeated in a second cycle and on the presence each time of fully developed mucus, indicated simply by its abundance, ductility and clarity. The time to conception was inversely related to the number of motile sperm seen. Simpler analysis showed a fivefold greater chance of conception associated with a positive compared with a negative PCT; after 2 years the cumulative conception rates were 84 and 16% respectively.

10 - Luteal Phase Dysfunction

Direct and indirect measures of progesterone secretion are the basis for assessing corpus luteum function. Despite methodological advances such as radioligand binding assays for the hormone, the frequency with which corpus luteum defects result in infertility or early abortion remains a matter of contention. The contention arises in part.from the fact that not all defects in corpus luteum function have a common aetiology and in part from failure to adhere to strict criteria for diagnosing or for determining response to treatment in the published accounts of studies of these disorders. In concluding this review, additional consideration will be given to some of these issues. From the point of view of current concepts about the aetiology of dysfunctional corpora lutea, it seems clear that both follicle development leading to ovulation and subsequent corpus luteum function result from a sequence of dose-related gonadotrophin-dependent responses in follicleschosen for ovulation. These responses include granulosa cell proliferation, differentiation of granulosa cells into luteal cells, and hormonally-dependent steroidogenesis by these cells. Failure of any step in the sequence ofevents may be expressed clinically by defective corpus luteum function coupled with failure to establish or to maintain early pregnancy. However, it should be apparent that any single therapeutic regimen directed towards normalizing corpus luteum function would not be equally effective for all aetiologic variants. Moreover, failure to distinguish between aetiologic variants in the population under study complicates interpretation of data purporting to describe incidence or response to treatment. A second problem arises from failure to adhere to uniform criteria for diagnosing defects in corpus luteum function. Before radioligand binding assays became available, clinical assessment of progesterone secretion (and thus of corpus luteum function) was based on cyclic changes in patterns of basal body temperature, on the quantity and quality of endocervical mucus, on endometrial morphology, or on measurements of pregnanediol (the principal urinary metabolite of progesterone), or combinations of these. Clearly each of these tests involves responses which are at least one step removed from progesterone secretion and thus subject to other variables. Thus a population of patients chosen on the basis of reduced levels of progesterone in randomly collected blood specimens might be dissimilar to a population chosen on the basis of endometrial biopsies. A third problem relates to variations in clinical expression before, and responses after, treating defects in corpus luteum function. Thus both failure to establish, and failure to maintain, pregnancy have been shown to occur among women with asynchronous secretory transformation of the endometrium and reduced mean integrated luteal phase serum progesterone levels. Furthermore, giving sufficient progesterone to restore blood levels of the hormone to ‘normal’ or to correct the delay in endometrial differentiation is not uniformly effective in restoring fertility or in preventing abortion. Given these sources of contention, how can the clinician confidently diagnose and treat women presenting with disorders of corpus luteum function? To our knowledge, the comparative reliability of direct and indirect methods for measuring progesterone secretion has not been subjected to vigorous examination. Under the circumstances physicians should familiarize themselves with the virtues and limitations ofa test which will perform reliably for them from patient to patient. For this purpose we recommend endometrial biopsies for use in monitoring corpus luteum function in women undergoing evaluation prior to treatment of infertility or early abortions. Furthermore, we believe that anomalous secretory transformation in this target tissue correlates reliably, albeit imperfectly, with both reduction in progesterone secretion and therapeutic efficacy of replacement therapy with the steroid in women with these disorders. Otherwise, physicians must engage in long and expensive, and often ineffective, empirical trials of therapy.

Immunological characterization of endocervical mucus in normal and neoplastic tissue.

Immunological characterization of endocervical mucus in normal and neoplastic tissue.

Effect of estradiol-17 beta on endocervical cytodifferentiation and glycoprotein biosynthesis in the ovariectomized rabbit.

In this study we tested the hypothesis that estrogen affects the cytodifferentiation of endocervical cell types. Applying a unit gravity sedimentation procedure to pronase-dispersed endocervical cells, four cell types were isolated from estrous rabbits. Two of these cell types contained histochemically distinguishable (periodic acid-Schiff; PAS) glycoproteins and were designated vacuolated and granular PAS-positive cells. The third cell type, which did not contain secretory granules, was designated as vacuolated PAS-negative; the fourth cell population consisted of ciliated cells. These different cell populations and their biosynthetic capabilities were compared with endocervical cell populations from ovariectomized and ovariectomized estrogen-treated animals. As a result of ovariectomy, the endocervix was composed of ciliated cells and of a population of degranulated cells that were no longer involved in mucus glycoprotein biosynthesis, as indicated by negligible incorporation of a glycoprotein radiolabeled precursor ([14C]-N-acetyl-D-glucosamine). Estrogen administration (5 μg estradiol-17βanimal/12 h for 10 days) to ovariectomized rabbits resulted in the restoration of endocervical cell types whose morphological and biosynthetic characteristics were comparable to those of cells from estrous rabbits. Collectively, these data support the hypothesis that estrogen plays a significant role in maintaining both the cytoarchitecture and the biosynthetic activity of endocervical epithelium. This study also shows that the ovariectomized rabbit may represent a useful model in which to study the mechanism of estrogen action on endocervical mucus glycoprotein biosynthesis.

Artificial Insemination with Husband’s Semen: Prognostic Factors

This retrospective review of 38 couples has considered 148 cycles of artificial insemination with husband's semen (AIH) and 178 cycles of natural insemination with husband's semen (NIH). The indication for AIH in every case was that postcoital testing had revealed less than 15 motile sperm/high-power field of endocervical mucus. Conception through AIH occurred in 12 cases; 1 couple conceived by NIH. The rate of conception per cycle was significantly higher in the AIH cycles than in the NIH cycles (P < 0.005). No man with both low density (less than 25 million spermatozoa/ml) and low motility (less than 50%) on semen analysis produced a pregnancy through AIH. Couples demonstrating more than 15 motile sperm/high-power field (on examination of cervical mucus 2 hours after AIH) were more likely to conceive through AIH than couples demonstrating less than 15 motile sperm. The role of AIH is discussed.

The Ovulation Method—Vulvar Observations as an Index of Fertility/Infertility

Channel formation in dried cervical mucus and the presence or absence of fern formation are correlated. The mean number of channels was 9.2 when the fern was negative 42.8 when the fern was poor positive and 73.9 when the fern was good positive. The difference between the means in the 3 groups was statistically significant (p < .0001). The channel number in dried cervical mucus and the presence or absence of fern formation are correlated with the day of the menstrual cycle in which the specimens were obtained and with the womans observation of the PEAK mucus symptom while using the ovulation method of natural family planning. The data organized itself more clearly when it was related to the womans observation of the PEAK symptom. This has been explained by the fact that the PEAK mucus symptom is essentially an ovulatory event. The reliability of the womans vulvar observations while using the ovulation method was tested against observations of cervical mucus obtained from the level of the endocervix. In those vulvar observations that are considered fertile by the method the channel number and the frequency of good positive ferning were higher than in those observations that are considered infertile. When the vulvar observations that indicate fertility were compared with those vulvar observations that indicate infertility the difference was statistically significant (p < .01). Finally a practical model of human fertility is described using practical experience with the ovulation method the womans vulvar observations while using the method and the channel and fern formation of endocervical mucus. A progressively declining index of fertility is described that is statistically significant.(AUTHORS MODIFIED)

The Effect of Copper Intrauterine Devices on Endocervical Gonococcal Cultures

The frequencies of positive endocervical Neisseria gonorrheae cultures in women using a conventional or a copper-bearing-type IUD were compared. 155 women who wanted to use IUDs were randomly assigned to 1 of 2 IUD groups. These women received either a conventional-type (Dalkon shield) or a copper-bearing device (copper T-200). The women were later brought back for an examination after wearing the device for 1-18 months. An endocervical culture was performed for each woman for the detection of Neisseria gonorrheae. There was no significant differe nce in the frequency of positive cultures in the 2 IUD groups. There were 5 positive gonococcal cultures (8.1%) in the conventional IUD group and there were 7 positive gonococcal cultures (7.5%) in the copper IUD group. The findings suggest that the increased concentration of copper in the endocervical mucus does not affect this organism.

Use of the Y chromosome in prenatal sex determination.

REPEATED observations of the cellular composition of human endocervical mucus from the earliest weeks of pregnancy, using various staining techniques, have revealed not only cells of maternal origin, but also choridnic cells which have been shed into the fairly static cervical mucous plug.

The isolation of tubercle bacilli from endocervical mucus of infertile women

As infertility is a common and important after-effect of genital tuberculosis in women, an attempt has been made to isolate tubercle bacilli from endocervical mucus of a consecutive and unselected series of 119 women complaining primarily of infertility and clinically unsuspected of genital tuberculosis. Guinea pig tests have demonstrated the presence of tubercle bacilli in endocervical secretions of 7 (5.9 per cent) cases. Culture and microscopic examination gave very poor results. All the strains of tubercle bacilli isolated were found to be of the human type. Three strains showed resistance to streptomycin and P.A.S. Six patients, or 5 per cent, of 119 patients presumably sterile, became pregnant during the period of observation. The figures obtained from the study are too small for statistical treatment, but they are nevertheless informative. As the results of the present findings, it is suggested that bacteriologic examination for tuberculosis of endocervical mucus of all patients with infertility should be a routine procedure.

Comparative bacteriology of the endocervical mucus

The results of 316 cultures of endocervical mucus are reported. One hundred and thirty-nine specimens were taken from women who desired to be fitted with an intrauterine contraceptive device, 112 specimens were taken from women who required tubal insufflation because of infertility, and 65 specimens were taken from women prior to cauterization of the cervix. Except for the finding of tubercle bacilli in 2.7 per cent of the infertility cases, in general, there was no significant qualitative or quantitative difference in the bacterial flora grown from specimens of these three groups of patients.