Link Between Abnormal Cervical Mucus And Fertility
Overview of Infertility
Infertility is usually defined as the inability of a couple to conceive after one year of unprotected intercourse.
Infertility is defined as a disease by the World Health Organisation(WHO).
Frequent, unprotected intercourse results in conception for 50 per cent of couples within three months, for 75 per cent within six months, and for 90 per cent within one year.
Infertility can be caused by the following:
•Sperm disorders (≥ 35 per cent of couples)
•Ovulatory dysfunction or decreased ovarian reserve (about 20 per cent )
•Tubal dysfunction and pelvic lesions (about 30 per cent )
•Abnormal cervical mucus (≤ five per cent )
•Unidentified factors (about 10 per cent )
Inability to conceive often leads to feelings of frustration, anger, guilt, resentment, and inadequacy.
Couples wishing to conceive are encouraged to have frequent intercourse when conception is most likely – during the six days, and particularly the three days, before ovulation. Ovulation is most likely to occur about 14 days before the onset of the next menstrual period.
Measuring morning basal body temperature (BBT) daily can help determine when ovulation is occurring in women with regular menstrual cycles. A decrease suggests impending ovulation; an increase of ≥ 0.5 °C suggests ovulation has just occurred. However, commercially available luteinising hormone (LH) prediction test kits, which identify the midcycle LH surge, are probably the best way for women to determine when ovulation occurs and are less disruptive than measuring BBT. BBT can be useful if women cannot afford or do not have access to LH prediction kits. There is no evidence that any test determining when ovulation occurs improves the likelihood of pregnancy in couples having regular intercourse.
Excessive use of caffeine and tobacco, which can impair fertility, is discouraged.
If these measures do not result in pregnancy after greater than one year, both partners are evaluated. Evaluation begins with history, examination, and counseling. Men are evaluated for sperm disorders, and women are evaluated for ovulatory and tubal dysfunction and pelvic lesions.
Evaluation is done sooner than one year if
•The woman is greater than 35.
•The woman is known to have a decreased ovarian reserve ( for example, because she has only one ovary).
•The woman has infrequent menses.
•The woman has a known abnormality of the uterus, fallopian tubes, or ovaries.
•The man is known to be subfertile or is at risk of subfertility.
Evidence that men less 45 are less fertile than younger men, regardless of their female partner’s age, is increasing.
Abnormal cervical mucus
Abnormal cervical mucus may impair fertility by inhibiting penetration or increasing the destruction of sperm.
Normally, cervical mucus is stimulated to change from thick and impenetrable to thin and stretchable by an increase in estradiol levels during the follicular phase of the menstrual cycle. Abnormal cervical mucus may
•Remain impenetrable to sperm around the time of ovulation
•Promote sperm destruction by facilitating influx of vaginal bacteria ( for example, due to cervicitis)
•Contain antibodies to sperm (rarely)
Abnormal mucus rarely impairs fertility significantly, except in women with chronic cervicitis or cervical stenosis due to prior treatment for cervical intraepithelial neoplasia.
Diagnosis
•Examination to check for cervicitis and cervical stenosis
A pelvic examination is done to check for cervicitis and cervical stenosis. Cervicitis is diagnosed if women have cervical exudate (purulent or mucopurulent) or cervical friability. Complete cervical stenosis is diagnosed if a 1- to 2-mm diameter probe cannot be passed into the uterine cavity.
Postcoital testing of cervical mucus to determine whether viable sperm are present (which used to be routine during infertility evaluation) is no longer considered useful.
Treatment
Assisted reproductive techniques (intrauterine insemination or in vitro fertilisation)
Treatment may include intrauterine insemination and in vitro fertilisation. However, whether either treatment is effective is unproven.
No evidence using drugs to thin the mucus (for example, guaifenesin) improves fertility.