Qus & Ans: Cervical Fluid Conditions & Post-coital Tests

Qus & Ans: Cervical Fluid Conditions & Post-coital Tests

Dear Doctor,
I am a 26 year old woman, I already have one son whom I conceived naturally without any medication. However, for the past two years I have been trying to get pregnant and have not suceeded. I have been married six years and have never used contraceptives. I have now been on infertlity treatment for the past year. It doesn't seem to be working, I don't know what's going wrong but I am becoming really desperate now. I am having clomid and Perganol injections and I know that I am ovulating every month. I have heard that there is a condition where the cervical mucas is not compatible with the husbands sperm and that usually results in all the sperm dying before they are able to travel any furhter. Do you think that maybe I suffer from this condition, if so what can I do? Please help me.
Thank you.

While there are certainly patients who have thick cervical mucous as a contributing cause of their infertility, this is rarely the only factor. Often, fertility drugs are combined with intrauterine inseminations, and this bypasses any effects of hostile cervical mucous. There may an extremely rare couple with antibodies or "allergies" to sperm, but I would concentrate on looking for more common causes of infertility.

The basic tests for a patient with secondary infertility (one with prior success) are the same as with primary infertility, and usually involve a test of the uterus and tubes (a hysterosalpingogram), a test of ovarian function or egg quality (a Day 3 FSH and Estradiol level), and a test for sperm quality (a semen analysis). Good luck.

Alan B. Copperman, M.D.
Director, Mount Sinai ART Program
New York, NY

Dear Docs -
I am a 31 year old female. My husband and I have just started trying to conceive our first child. I was on the pill (Ortho-Novum 777-28) for 12 years, and went off in September 98. My OB/GYN advised me to wait 3 months before really starting to try, but I, of course, thought I would get pregnant immediately, which I did not. I have been charting my BBT and cervical mucus for two months - I feel that I am definitely ovulating because I have the spike in temp., and a luteal phase of 12 days. What I am concerned about, however, is that I have not had excessive amounts of cervical mucus either month, nor has it changed consistency that much (does not get "stretchy").I can't seem to find any info on lack of cervical mucus or causes...should I be concerned or is my body still adjusting? Thanks!

Dear Patient:
It is true that Dr. Billings in the 70s described how the cervical and vaginal mucus changed during the different phases of the menstrual cycles. He emphasized how the mucus has significant volume, water content, salts and muco-polysacarides in the immediate pre-ovulatory cycle. He also described the increased spinberkheit ("stretchyness") coinciding with the pre-ovulatory estradiol rise.

Clinical practice, however, differs quite a bit from the ideal Billing's postulate. In a study published at Yale Medical School in the mid 80's there was no difference in pregnancy rates when all those physical characteristics were compare in approximately 1,200 infertile patients. Furthermore, a normal post coital test (Sims Huhner test) did not improve the probability of those patients to succeed. Thus, many practitioners do not test for cervical mucus nor post coital tests any more. These tests do not appear to be neither predictive nor cost effective.

Sincerely,

Jaime Vasquez, M.D.
Voice: (615) 321-8899 ~ FAX: (615) 321-8877

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