Hostile Cervical Fluid (Mucas)

Part of what makes understanding fertility so difficult is that there are so many aspects that need to be considered, from sperm motility to egg quality and everything in between. Cervical mucus, a jelly-like substance produced by glands in the cervical canal, is a factor in a woman's fertility. Just how important a factor it is remains controversial.

Cervical mucus changes in consistency and composition with the menstrual cycle. Toni Weschler, author of -Take Charge of Your Fertility,° compares cervical fluid to seminal fluid in men. In other words, men are fertile every day and produce semen everyday. On the other hand, women are only fertile a few days each cycle, around the time of ovulation. The rest of the time, women arenît fertile and have very little or very sticky cervical fluid.

Just before ovulation and under the effect of the hormone estrogen it becomes very watery and copious to allow the sperm to swim through it. After ovulation and under the effect of progesterone, the mucus becomes thick and sticky, which render it impenetrable to the sperm. Once the sperm are in the mucus, they can stay there for a few days.

How do I check?

You can monitor your cycle by determining the color and consistency of your cervical mucus. This can be done using either your fingers or toilet paper. In most women, cervical mucus varies from dry, to sticky to creamy, to egg white just prior to ovulation. However, in some women, changes in cervical mucus can be difficult to detect.

During a typical 28 day cycle, the consistency of cervical mucus should be as follows:

• Days 1-5 Menses
• Days 6-9 Dry, or little to no mucus
• Days 10-12 Sticky, thick mucus, becoming less thick and whiter.
• Days 13-15 Egg-white mucus ò thin, elastic, slippery and clear. Indicates most fertile time.
• Days 16-21 Sticky, thick mucus
• Days 22-29 Dry mucus

Post-Coital Check

Your physician may want to do a post-coital test as a part of an infertility work-up. It might be indicated in cases of unexplained infertility, particularly in cases where the female is known to be ovulating and/or a male's semen analysis is normal. The test is painless and meant to determine if you have hostile cervical mucus. Cervical mucus hostility is the inability of sperm to penetrate the cervical mucus. The significance of cervical mucus hostility is disputable among infertility specialists.

Timing is very important since only mucus at or around ovulation time is not normally "hostile". You are generally instructed to have intercourse in the morning and come into the office within a certain number of hours. The Post Coital Test involves the sampling of the cervical mucus between 4-10 hours after intercourse where a sample of your cervical mucus is taken and examined under the microscope for evidence of live and healthy sperm.

The test may indicate bacterial infection, antibodies in mucus that reject sperm, mucus that is too thick for sperm passage, too little mucus for sperm passage, or abnormal semen resulting from male sperm antibodies. The test run between $100-200.

There is some discussion over how helpful the PCT really is. It has not been proven to be valuable based on randomized prospective studies. According to researcher Mark Hornstein, "The postcoital test ... has come under increasing scrutiny in recent years. We question the validity of the postcoital test as a diagnostic tool in the evaluation of infertility."

However, some physicians feel that it can be of value in many clinical situations. In a study published in the Journal of Human Reproduction, researchers found that the PCT was helpful only if infertility was occurring for less than three years. After three years, they concluded, there was true unexplained infertility.

What causes it?

There are several possible causes of hostility. The mucus may be too sticky and thick (and there is not enough of it to allow sperm to swim through). This may be due to poor estrogen stimulation of the cervical glands (e.g. wrong timing of the test or lack of ovulation) or poor functioning cervical glands due to infection or damage caused by surgery, as may occur after a biopsy. Also, the mucus may not be compatible with the partnerîs sperm because of antisperm antibodies. Lastly, the sperm could be abnormal or defective.

How is hostile mucus treated?

There are a number of treatment options available to a patient with cervical mucus hostility. Treatment options may include antibiotics if there is an infection, estrogen tablets to make mucus more fluid, and IUI and IVF there are antisperm
antibodies present. Some specialists may recommend a course of steroids to stop the antibodies from developing. To be effective they have to be given in a high dose and over a long period of time. It should be noted that steroids do not always work and are associated with significant side-effects.

Evening Primrose Oil (EPO) may also aid in the production of fertile quality cervical fluid. EPO is an essential fatty acid that contains gamma linolenic acid (GLA). It is converted to a hormone-like substance called prostaglandin E1. EPO helps the body to produce more fertile quality cervical fluid also known as -egg white cervical mucus.° EPO should only be taken from menstruation to ovulation. This is because EPO can cause uterine contractions in pregnancy. The dosage taken should be 1500mg to 3000mg per day. This may take a month or two to build up and produce the results you are looking for. It is imperative that you chart your fertility symptoms and signs, so you can know when you have ovulated and can discontinue the EPO. It is important to note that Evening Primrose Oil has estrogenic properties and should not be taken if estrogen levels are
already high.

Does Robitussen Really Work?

In chat rooms across the internet, hundreds of women swear by taking two tablespoons of cough medicine (any expectorant that contains guaifenesin as the only active ingredient) before ovulation as a means of making cervical mucus more hospitable. While anecdotal evidence may abound, there is little scientific evidence to back it up. There is, however, one twenty-year old study that indicates it can be helpful in thinning cervical mucus.

If you are going to take it, you would use it about five days before ovulation and including the day of. However, when you are trying to conceive, you should talk to your physicians about any medications you are taking, even over the counter ones. There are some women who have allergic reactions to it, although it is generally considered to be safe.

Journal Articles:

The prognostic power of the post-coital test for natural conception depends on duration of infertility
Glazener CM, Ford WC, Hull MG Health Services Research Unit, University of Aberdeen, Aberdeen and University of Bristol, Division of Obstetrics and Gynaecology, Bristol, UK
Hum Reprod 2000 Sep;15(9):1953-1957

In-vitro Cervical Mucus-Sperm Penetration Tests and Outcome of Infertility Treatments in Couples with Repeatedly Negative Post-coital Tests," Human Reproduction January 1995;10(1): 85-90).

"The Reproducibility of the Postcoital Test: A Prospective Study," Obstestrics and Gynecology, March 1995; 85:396-400).

Improvement of Cervical Factor with Guaifenesin by Jerome H. Check,M.D., H.G Adleson, B.S., Chung-Hsis Wu, M.D. Fertility and Sterility, May 1982

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