Cervical Factor: Abnormalities of Sperm - Mucus Interaction

Once sperm are ejaculated into the vagina they must swim through the cervical mucus, pass the cervix, and enter the uterus. Their final destination is the end of the fallopian tube, where fertilization occurs. Sometimes there are abnormalities in the cervical mucus that can slow, damage, or destroy sperm. Some medications, notably Clomid, can cause a thickening of the mucus making sperm transport difficult.

It is possible that the female, or rarely the male, produces antibodies to the sperm. The body "mistakes" the sperm for invading pathogens and the immune system produces antibodies to destroy them. This is essentially the same reaction seen when the immune system identifies a foreign virus. The male may produce antibodies to his own sperm. There must have been "semen - blood" contact in the past for the body to produce these antibodies. This most often occurs as a result of testicular trauma.

A first line treatment for cervical factor may be intrauterine insemination ( IUI ). In IUI, specially prepared sperm are inserted directly into the uterus using a small catheter thus avoiding contact with the cervical mucus. If moderate male factor is present, or if there are other abnormalities in the female, IVF may be the best treatment choice.

When poor cervical mucus is the only cause of infertility treatment success rates are typically high.

Post Coital Test ( PCT )

The post coital test has been the traditional method for identifying cervical factor infertility. Recommended techniques, timing, and interpretation have varied widely. However, all involve collection of a specimen of cervical mucus ( by aspiration with a syringe ) shortly before the expected time of ovulation a few to several hours ( typically 2 - 12 hours ) after intercourse. The PCT includes both a gross and microscopic examination to grade mucus characteristics and to assess the number and motility of surviving sperm.

The most common explanation for poor results or a "negative" PCT is improper timing. Other potential explanations for poor quality mucus include cervicitis ( inflammation of the cervix ), previous injury to the endocervical glands resulting from treatment for abnormal Pap smears, and treatment with antiestrogens ( Clomid ). Possible explanations for the absence of motile sperm in good quality mucus include ineffective coital technique, failed ejaculation, poor semen quality, and use of coital lubricants that may be toxic to sperm.

Observation of immotile, "shaking," or agglutinated ( clumped ) sperm may indicate the presence of antisperm antibodies that may be present in either partner. By far the most popular approach to the treatment of cervical factor infertility has been to bypass the cervix by performing direct intrauterine insemination ( IUI ).

Hyperprolactenemia

Abnormally high levels of the hormone prolactin ( hyperprolactinemia ) can cause oligoovulation ( irregular or infrequent menses ). Increased levels are often caused by a nonmalignant tumor at the base of the pituitary gland. Symptoms of hyperprolactinemia can include excess breast milk production, because prolactin stimulates this process during pregnancy. This condition can often be treated with a medication called bromocriptine ( Parlodel ) that decreases prolactin levels. Rarely surgery is needed to remove the tumor.

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