Cervical mucus

Cervical mucus

Fern testFern test refers to visualization of a characteristic 'fern-like' pattern on a slide (pre-cleaned, saline free slides are required), viewed under low power on a microscope.1. a small amount of cervical mucus is allowed to air-dry on a clean, saline-free glass slide. In the presence of high levels of estrogen, just prior to ovulation, the cervical mucus forms fern-like patterns due to crystallization of sodium chloride on mucus fibers.

The Fern test is used to provide indirect evidence of ovulation and fertility, however this test does not predict the time of ovulation. Ferning is due to the presence of sodium chloride in the mucus under estrogen effect. This pattern is known as arborization or 'ferning'.

When the influence of estrogen starts to decline while that of progesterone increases, the arborization pattern becomes ill-defined. It is completely absent during the pre- and postmenstrual phase (22nd day of cycle). Persistence of Ferning throughout menstrual cycle suggests an-ovulation (infertility). This is also true after menopause, and in autonomic ovarian failure.While the dried mucus is being examined for arborization, the leukocyte content of the mucus should also be assessed. Leukocytes are abundant during the early proliferative phase and luteal phase, but sparse at ovulation due to the influence of estrogen. Any deviation from this pattern is justification for a bacteriologic study, perhaps with a resistance test.

Huhner testThe Huhner test is a type of fertility test in which the compatibility of sperm and cervical mucus is evaluated. This is an important test because up to 8% of infertility cases are related to incompatibility between cervical mucus and sperm. The Huhner test, also known as the Sims-Huhner test or the postcoital test, is carried out by an infertility diagnostician, who examines these fluids several hours after intercourse has taken place.

Cervical cells secrete mucus which changes in consistency according to different phases of the menstrual cycle. As the cycle approaches the time of ovulation, cervical cells produce larger quantities of mucus. The mucus also changes qualitatively, to approximate a pH and viscosity that is more compatible with sperm migration. For sperm to travel past the cervix and into the uterus, the mucus present in the cervix must generally be of pH 7 to 8.5, and have a certain degree of viscosity and stretch. Infertility may result if the cervical mucus and sperm are incompatible.

To determine whether cervical mucus has the required pH and viscosity, the Huhner test is carried out several hours after intercourse, on a date close to the womans time of ovulation. Generally, a couple undergoing the test is asked to avoid intercourse for 48 hours prior to the test, and to then have intercourse four to eight hours before the test appointment is scheduled. During the test appointment, mucus samples are collected from the womans cervix and are then examined in a diagnostic lab.

Several different aspects of the cervical mucus are evaluated during a Huhner test. First, the mucus is examined for clarity and viscosity. Mucus obtained from the cervix at the time of ovulation should be clear and watery, and viscous enough that a portion of the mucus can be stretched at least 3.15 inches (8 cm) before breaking. The pH of the mucus is also recorded; the optimal level is pH 7 to 8.5.The next part of the Huhner test involves the microscopic examination of the mucus to check how many sperm are present. A drop of mucus should contain a dozen or more sperm, which should swim with a strong forward motion. If there are too few sperm, this may indicate that the pH of the mucus is too low for sperm to survive. If sperm are unable to swim strongly, the mucus may be too thick. The presence of other types of cells, including immune cells and yeast cells, is also noted. If larger than normal numbers of immune cells are present an infection may be affecting the quality of cervical mucus. Similarly, the presence of yeast cells indicates an infection that may also affect survival and motility of sperm. In some cases, resolving the infection will improve mucus quality enough to allow the woman to conceive.If the quality of a womans cervical mucus is reducing her ability to conceive, and this problem has no other underlying cause, she may be prescribed hormonal medication that can improve the quality of the mucus. When medication does not resolve the problem, artificial insemination may be recommended. This procedure enables sperm to bypass the cervical mucus, improving the chances of conception.Sperm Mucus Penetration TestThis part of the sperm penetration tests involves both the female and male partner. To do this test, the female partner will have her menstrual cycle monitored in order to detect ovulation (indicated by a rise in LH levels). Once ovulation has been detected, a sample of the womans cervical mucus will be taken.On the day of the test, the male partner will provide a fresh semen sample through masturbation, using a sterile cup to collect his ejaculate. Sperm from the semen sample will then be introduced to the cervical mucus and left for 90 minutes. After this time, the sperms motility will be evaluated by measuring how far the sperm was able to travel through the cervical mucus.

If abnormal results are found, meaning that the sperm has not traveled very far, the test will be repeated, first with the females cervical mucus and donor sperm known to be fertile, then with the males sperm and cow mucus (which is similar to human cervical mucus and more readily available) or fertile human donor cervical mucus. Based on these results, fertility doctors will be able to discern whether the fertility problem lies in the males sperm or the females cervical mucus.If sperm is found to clump together on contact with the cervical mucus, then it is likely that either the males sperm or the females mucus contain antisperm antibodies.