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Objective To investigate asymptomatic shedding from the uterine cervix of five human herpes viruses: cytomegalovirus (CMV), Epstein–Barr virus (EBV), herpes simplex virus (HSV) type 1 and type 2 and varicella zoster virus (VZV), in young women. Design A descriptive study. Setting Sahlgrenska University Hospital. Population Three hundred and five young, healthy Swedish women. Methods Cervical specimens were analyzed for the presence of viral DNA with a quantitative real-time PCR assay. Main outcome measures Detection of viral DNA. Results Viral DNA was detected in 66 (21.6%) of the cervical samples. The most common findings were CMV DNA, detected in 35 (11.5%), and EBV DNA, found in 32 (10.5%) of the women. HSV-1 DNA was detected in 5 (1.7%) and HSV-2 DNA in 4 (1.4%), but VZV DNA was not found. The estimated DNA level for the detected viruses was similar with a mean DNA quantity of 2.6 log genome equivalents (Geq)/mL for CMV (range 1.7–4.3), 2.5 log Geq/mL for EBV (range 1.7–4.7), 2.4 log Geq/mL for HSV-1 (range 1.7–3.5) and 2.6 log Geq/mL for HSV-2 (range 1.7–4.1). The simultaneous presence of DNA from two or more herpes viruses was detected in eight specimens. Conclusions Asymptomatic shedding of CMV and EBV from the uterine cervix was found in one-fifth of young women. In four of the cervical samples; two with EBV, one with CMV, one with HSV-2, high amounts of viral DNA (>4 log Geq/mL) were detected suggesting a greater risk of transmitting the virus perinatally or sexually.

Background. The aim of this study was to investigate the influence of the solid phase of the mucus hydrogel in facilitating the upward movement of spermatozoa during the menstrual cycle. Methods. A total of 171 sperm migration experiments using 47 selected ovulatory mucus samples were performed in vitro in tubes of various shape and diameter. Physical constraints applied to cervical mucus combined with scanning electron microscopy (SEM) techniques permitted analysis of the mechanism of sperm orientation within cervical mucus submitted to capillary constraints simulating the various conditions of sperm orientation in vivo . Results. The results support the theory according to which spermatozoa entering the cervical canal are constrained to follow the oriented micellar lines of strain. Stretched ovulatory mucus exhibits noticeable prevalent orientation of most filaments aligned in a manner roughly parallel to the traction axis. By contrast, even after strong stretching applied to luteal-type mucus and longe...

Medication with Clomiphene Citrate and its effects on the quality of cervical mucus and the addition of exogenous estrogens in order to suppress abnormal mucus secretion are controversial issues. We have prospectively studied a group of 19 anovulatory women who were treated with clomiphene citrate in order to characterize those patients most likely to respond to the addition of exogenous estrogens. On day 14 of the cycle, 17 beta estradiol and cervical score were measured and 1 mg estradiol benzoate was injected intramuscularly. Cervical scores were below 7 in 12 out of the 19 patients before estradiol benzoate administration. In these patients, 17 beta estradiol rose from 751 +/- 541 to 1321 +/- 648 pg/ml (p less than 0.03), and cervical scores rose from 3.75 +/- 2.1 to 7.1 +/- 3.7 (p less than 0.01), after estradiol benzoate administration. Patients with cervical scores of 8-12 did not improve significantly. In the 12 patients with cervical scores below 7, those (n = 6) with 17 beta estradiol below 600 pg/ml experienced a significant improvement in cervical score, in contrast to those (n = 6) with 17 beta estradiol above 600 pg/ml who had no improvement. The reduction in cervical mucus accomplished with clomiphene citrate can be further improved by adding exogenous estrogens, mainly in patients who have low 17 beta estradiol levels concomitant with low cervical score.

Uterine cervical mucus is crucial for reproduction, facilitating sperm transport and survival in certain mammals. Cholinergic autonomic nervous secretory innervation has been established, and modulation of secretion by prostaglandins and non-steroidal anti-inflammatory drugs has been postulated. It has been suggested that glandular nitric oxide (NO) production is a prerequisite for the autonomic cholinergic nervous modulation of cervical, endometrial, and the seminal vesicle secretion in the guinea pig. Most secretory genital tract cells, female as well as male, seem to display NO synthase activity.Cervical secretion at ovulation time was studied in 10 women with regular menstruation. In an in vivo model with repeated collection of mucus samples during four 60-min periods, the amount of mucus was estimated in a control experimental series and in an experimental series following sublingual administration of the NO donor nitroglycerin.This nitroglycerin administration markedly increased cervical secretion, while no changes in cervical secretion were seen in the control experimental series.The results suggest that glandular NO production increases cervical secretion. Thus, cervical secretion may, apart from hormonal regulation, be influenced by the autonomic nervous system, and in addition, NO may be a prerequisite for this influence. This in turn may have implications on fertilization and fertility regulation.

Fetal fibronectin (FFN) in cervical secretion is one of the most effective markers of pre-term and term delivery. The presence of FFN in cervicovaginal secretions has recently been shown to reflect cervical state and an uncomplicated induction of labor at term. This study was designed to determine whether FFN could be a biochemical marker to predict the response to prostaglandins in early mid-trimester abortion.The presence of cervical FFN was evaluated by means of qualitative rapid immunoassay in 270 patients, who required second trimester termination of pregnancy at the Department of Gynecology and Obstetrics, University of Naples 'Federico II'. According to the standard protocol of our unit, women received 1.0 mg of gemeprost intravaginally at 3-hr intervals up to a maximum of five suppositories. The induction-to-abortion interval and the percentage of successful abortions within 24 hr in women in the positive FFN group (n=19) were compared with those in the negative FFN group (n=251).FFN in the cervical secretions was present in seven women (10.2%) at 16-weeks gestation, in seven women (7.5%) at 17-weeks gestation, and in five women (4.5%) at 18-week gestation. Final termination rates were 13 (68.4%) in the fibronectin-positive group and 177 (70.5%) in the fibronectin-negative group. The median abortion interval was similar (14.7 versus 15.1 hr) in both groups.A positive cervical fetal fibronectin test does not predict a successful medical termination of pregnancy in second trimester abortion. In this setting, the role of fetal cervical fibronectin in cervical ripening is, therefore, questionable.

The objective of this study was to evaluate the predictive value of interleukin-6 (IL-6) in cervical secretions for preterm delivery before 34+0 gestational weeks in patients with preterm labor.In this prospective study, 31 patients were enrolled with preterm labor and intact membranes. Cervical swabs were taken on admission and the concentration of IL-6 was measured. The gestational age at the time of admission and delivery, as well as the time interval to delivery, were evaluated and compared with the concentration of IL-6 on admission.Cervical IL-6 was significantly elevated in the preterm delivery group (34+0 gestational weeks, p0.05). Choosing 20 pg/ml as a cut-off concentration, cervical IL-6 had a sensitivity and negative predictive value of 100%, a specificity of 67% and a positive predictive value of 47%. Concerning the time interval to delivery, the sensitivity of IL-6 was 100% and the specificity 57% for delivery within 2 days and 100% and 64% for delivery within 7 days.Cervical IL-6 is a new, promising diagnostic tool to identify patients at high risk of preterm delivery.

In our studies on women with bacterial vaginosis (BV) in early pregnancy a strong association has been found between BV and the levels of endotoxin or interleukin-1alpha (IL-1alpha) in the lower genital tract. In the present study we investigated if an association could be found between BV and other cytokines (IL-1beta, IL-6, tumor necrosis factor alpha, TNF) or fetal fibronectin (FFN). The cytokine-inducing capacity of endotoxins present in the cervical mucus was explored in a monocytic cell assay.Cervical mucus or cervicovaginal fluid was collected from women with (BV) and without BV (nonBV) attending a family planning unit for first trimester abortion. The concentrations of IL-1beta, IL-6, TNF and FFN were determined by quantitative enzyme immunoassays. TNF was determined in 63 women (BV, n=25) out of whom 37 (BV, n=11) were analyzed for IL-1beta and the remaining 26 for IL-6 (BV, n=14). FFN was determined in another 36 women (BV, n= 19). The cytokine-inducing capacity of endotoxin-containing cervical mucus and purified endotoxin of Prevotella bivia were studied by an in vitro cell assay using a human monocytic cell line (THP-1).IL-lbeta and IL-6 were found in almost all women. The levels of IL-1beta, but not IL-6, TNF or FFN, were significantly increased in women with BV compared with the nonBV women (p0.05). Purified endotoxin from P. bivia, and cervical mucus from BV women containing high levels of endotoxin were able to induce a cytokine response (IL-6) in monocytic cells in vitro.BV is associated with increased levels of IL-1beta in the lower genital tract of pregnant women in the first trimester. The ability of BV-associated endotoxins to induce cytokine production in monocytic cells may partly explain the increased IL-1beta levels.

This research was aimed to study the biochemical changes in cervical mucus after application of laminaria tent.Cervical mucus was collected before and after insertion of laminaria tent from 20 normal pregnant women in the first and second trimesters. Interleukin-1 beta, IL-8, collagenase activity, elastase activity, PGE2 and PGF2 alpha were measured in the collected samples. Laminaria tent was also inserted in one vaginal cervix of five non-pregnant rabbits and the clinical and histological changes were compared with five non-treated rabbits. Collagen contents were assessed histologically and Leukocyte number was counted.IL-1 beta and IL-8 and elastase activity were significantly increased after insertion of laminaria (p0.0001 and 0.001 respectively). Collagenase activity was not significantly changed. Whereas concentration of PGE2 and PGF2 alpha in the mucus were markedly increased (p0.0001 and 0.001 respectively). Collagen contents were significantly decreased in laminaria and opposite side cervices (p0.0001). No significant changes in leukocyte count could be observed in treated and non treated cervices.Insertion of laminaria leads to increase concentration of IL-1 beta, IL-8, PGE2, PGF2 alpha and elastase activity. Mechanical stretching of the cervix and biochemical changes in cervical mucus may explain the mechanism of cervical ripening induced by laminaria.

Granulocyte elastase (elastase)-like activity in 119 samples of cervical mucus from pregnant women was measured. Though elastase-like activity in normal pregnant women was low in 2nd and 3rd trimesters (less than 20 units), it increased during labor (1st stage of labor: 70 +/- 50 U/l; 2nd stage: 72 +/- 56). Elastase-like activity in pregnant women with imminent premature delivery (24-30 gestational weeks) was also high (78 +/- 57). Elastase-like activity of cervical mucus correlated with Bishop score in both normal term and preterm labor. Elastase-containing granulocytes were identified by immunohistochemistry in ripened cervix in normal and preterm labor. Some granulocytes degranulate and release elastase into the cervical stroma. Others migrate through the basement membrane of the endocervix to reach the cervical canal. Elastase could not be demonstrated in immature cervix as assessed by Bishop score. The staining intensity of elastase in the cervix correlated closely with elastase-like activity in cervical mucus. Thus elastase-like activity in cervical mucus reflects the degree of cervical maturation. These results lead one to speculate that elastase is one of the neutral proteases which depolymerize and degrade collagen in the ripening cervix.

The occurrence of Corynebacterium vaginale (Haemophilus vaginalis) and other micro-organisms in the cervix of healthy women and women with lower genital tract infections (LGTI) was studied. C. vaginale was isolated from 31.4% of 70 patients with LGTI, but not from any of 28 healthy controls. In 5.7% of the patients with LGTI, C. vaginale was the only organism recovered from the cervix. In the patients with LGTI the symptoms and signs did not vary with the presence or absence of C. vaginale. LGTI with C. vaginale could not be diagnosed with certainty from findings in wet mounts, Gram or Papanicolaou stained smears. C. vaginale was not isolated from any of the women in whom the vaginal smears revealed a flora with a predominance of bacilli morphologically of Ddderlein's type. The study also included evaluation of methods for isolating and identifying C. vaginale. In vitro C. vaginale was sensitive to all antibiotics tested with the exception of sulphonamides.

The in vitro conversion of [14C]arachidonic acid by endocervical mucosa and cervical tissue specimens obtained in first trimester (9-12 w) and term pregnant patients (37-39 w) was studied in whole-cell homogenates. All radiolabelled products of the arachidonic acid cascade were extracted, purified and separated utilizing silicic acid chromatography, thin-layer chromatography and reversed phase partition chromatography and identified with radio-gas chromatography and gas chromatography-mass spectometry. Both types of tissue produced PGF2 alpha and PGE2, as well as TxB2. In cervical tissue specimens there was a significant increase in the production of all these three prostaglandins as the pregnancy progressed, whereas no such difference was seen in homogenates of endocervical mucosa. In both endocervical mucosa and cervical tissue specimens there was a highly significant increase in the production of a so-far unknown compound(s), in samples from term patients as compared with samples from first-trimester patients. The possible participation of this metabolite of [14C]arachidonic acid in the regulation of cervical ripening is discussed.

Ultrastructural aspect and variations of cervical mucus have been studied by scanning electron microscopy in 58 pregnant and 29 menopausal women. In both groups, a striking tightening of the ultrastructural glycoprotein framework was demonstrated. The phenomenon appears to occur very rapidly at the beginning of pregnancy while patients near the menopause show more variable patterns. The results are compared to the known evolution of cervical mucus ultrastructure during the ovarian cycle and discussed from a rheological point of view. Particular attention was paid to the eventual antibacterial role of cervical mucus in pregnancy, which was found to be very plausible.

The effects of a 2-phase preparation on the parameters of cycle function were studied in 14 normally menstruating women. The preparation, Cyclabil, is administered in a series of 11 tablets with 2.0 mg oestradiol valerate and 10 tablets with 2.0 mg oestradiol valerate in combination with 0.5 mg D,L-norgestrel. The cervical function, the spinnbarkeit of the cervical mucus and its crystallisability and, by means of RIA, FSH, LH, 17beta-oestradiol and the progesterone serum levels were determined continuously in a control cycle before the treatment, in the first and third treatment cycles and in a subsequent control cycle. The results show that no impairment of the normal cycle function were found during cyclical administration of the 2-phase preparation in 13 women. Two pregnancies occurred during the therapy. The process of ovulation was inhibited in one subject during the medication. 20 other women with pronounced premenopausal deficiency symptoms and cycle irregularities were treated with the 2-phase preparation for 6 months. Apart from the good cycle regulation, the deficiency symptoms were eliminated completely in 19 women and almost completely in 1 woman. Checks of the FSH, LH, 17beta-oestradiol and oestrone serum levels conducted at random during a medication cycle showed only a slight influence on the gonadotropin level. During the medication, E2 can be demonstrated in comparison to E1 at a ratio of 1:10.

Samples of cervical mucus and endometrial tissue from 379 women who were infertile for various reasons were examined for the presence of Ureaplasma urealyticum, and the results were compared with those obtained in 40 fertile women. In the cervical samples U. urealyticum was present in about half of the women in both groups, whereas positive cultures from the endometrium were obtained significantly more often among the infertile patients (26%) than among the controls (7.5%). Between the different infertility subgroups (unaccountable infertility, infertility caused by tubal abnormalities, husband infertility and other known causes) no significant differences were found. The presence of U. urealyticum in the endometrium was asymptomatic and was not related to prior pelvic inflammatory disease. In 14% of the Ureaplasma-positive endometria, aerobic or anaerobic bacteria were demonstrated. A treatment trial was also included in the study, but did not arrive at any definite conclusion as to the specific role of endometrial Ureaplasma colonization in infertility.

Recent findings on the scanning electron microscopical (SEM) structures of epithelium of female and male reproductive organs spermatozoa placenta amniotic cells umbilical cord neonatal blood cells and pathologies of their structures - carcinoma of the endometrium cervix vagina and vulva - are reviewed. The methodology in preparation of soft tissue cervical mucus and amniotic tissues is described including pinning fixation dehydration and drying mounting and metal coating and viewing with the SEM. There are striking morphological differences between the tissue organization of the mucosa of different segments of the reproductive tract. These morphological di fferences are discussed in terms of observed physiological functions. SEM is a useful tool in studying infertility the status of the newborn monitoring fetal maturity and carcinoma diagnosis.

A method, capable of determining very small flow rates, 0.01–0.10 μ1·sec−1, is described. The technique, which is devised with the aim of measuring the rate and fluctuation in the flow of uterine secretions, is based upon the detection of the asymmetry in the dispersion of heat, added as a label. The accuracy in measurement of basal secretion rates over long periods of time is ± 15%, the accuracy in the detecting of flow fluctuations is ± 5%.

The aim of this investigation was to study the influence of freezing and thawing of semen on motility, penetration ability in cervical mucus and fertilizing capacity of spermatozoa. A total of 65 ejaculates was frozen and thawed. 50 specimens came from 7 heterologous insemination donors and 15 from homologous donors. Fresh ejaculates were studied and frozen immediately. After dilution in a progective medium the mixture was preserved in sealed plastic straws and cooled in liquid nitrogen. Storage time varied from 1 day to 5 weeks. Thawing was done in a water bath at 37 degrees C. The postthaw, otility, penetration ability and duration of motility in cervical mucus of spermatozoa were reduced by the freeze-preservation procedure. However in some of the samples spermatozoa had an unchanged penetration ability of cervical mucus. The women who were inseminated belonged to the sterility groups of the clinic but were apparently were performed in 14 women and 15 homologous inseminations in 4 women. No conceptions occurred after using semen preserved at 196 degrees C. Later the 14 women who had received heterologous insemination with freeze preserved semen were inseminated with fresh semen from the same donors and 8 conceptions occurred. From these results and reports by others it is concluded that postthaw mobility is a poor prediction of fertility. For fresh donor semen there is a significant correlation between conception rate and furation of sperm motility in postthaw specimens may explain in part the reduced fertility. Sperm density of the sample influenced motility recovery. Semen samples of law sperm density are not suitable for freeze preserving. Undetected damage to spermatozoa during freezing and thawing is thought to cause the discrepancy between fertility and the results of the tests. The fertilizing capacity of freeze-preserved semen was more reduced than expected.

The sperm penetration test introduced by Kremer was studied, using cervical mucus as the test medium and human semen samples with varying properties. The spermatozoa from semen samples of good quality penetrated rapidly, to more than 30 mm within one hour. Spermatozoa from semen samples of poor quality penetrated slowly and a maximum penetration of less than 20 mm was noted. Capillary tube size, incubation temperature, and the amount of mucus protruding from the capillary tube, had no appreciable influence on the results. Reproducibility was good. Storage of the cervical mucus at + 4°C or - 20°C for 3 weeks did not influence its suitability as a test medium. The test is easy to perform and well suited for routine semen analysis.

(1950). Sexual Cycle, Time of Ovulation, and Time of Optimal Fertility in Women. Acta Obstetricia et Gynecologica Scandinavica: Vol. 29, No. sup4, pp. 1-139.

Conluten (2 mg norethisterone plus mestranol) and Conlunett (1 mg norethisterone plus mestranol) were investigated in 71 women to determine the effect of the 2 doses of oral contraceptive on ovarian activity. 82% of the women receiving Conluten had impaired ovarian function according to cervical mucus viscosity and measurement of ovarian size. 45% of the Conlunett-treated women showed ovarian inhibition. The 37% difference in activity between the 2 goups was statistically significant. It is suggested that since both drugs have been shown to be effective contraceptives their contraceptive action may involve factors other than ovulation.

Depot Medroxy Progesterone Acetate 150 mg every 3 months was given to 231 women followed through 4 671 woman/months. The same progestogen in 300 mg dosage was given as six-monthly injections to 92 women followed through 904 woman/months. These two dosage schedules were 100% effective in fertility control, the crude drop out rate reached 33.7% and 51.0% respectively. The menstrual cycles were markedly disorganized. The re-establishment of normal menstrual and endometrial cycles and fertility after stopping therapy was reported. The effects on the genital organs, glucose tolerance, thyroid and liver function tests were studied.

Detection of tumour cells in cervicovaginal secretions nearly always indicates the presence of a malignant tumour or epithelial dysplasia. Presence of suspicious cells or cells with atypical nuclei very often suggests the existence of a malignant tumour or epithelial dysplasia (46 and 14%, respectively). The great majority of the remaining patients with such cytological changes suffer from other gynaecological diseases, most often of an inflammatory nature. A cytologic differentiation between these groups is not yet possible. Other examinations are therefore indicated. Cytological changes in the cervicovaginal secretion rise in frequency with increasing age. In 9% of the patients with carcinoma of the cervix no abnormal cells were detected in the cervicovaginal secretions. The corresponding figures for severe (“carcinoma in situ”) and moderately severe epithelial atypia were 22 and 31%, respectively. No more than one third of the patients with carcinoma of the uterine body had abnormal cytology. Hence, on...

The constituents of cervical mucus are water 90%; inorganic salts 1%; small amounts of low molecular organic compounds; and small amounts of high molecular organic substances including glycogen. The bulk of the solid material is formed by glycoproteins normally 1-6%. While the qualitative composition of the cervical secretion seems to be essentially constant there are considerable quantitative variations between the ovulatory and anovulatory phases. The physiological role of cervical mucus and its main function is to act as a protective barrier to the interior of the uterine cavity.

The structure of cervical mucus is described; the estrogen type (E type) allows spermigration whereas the gestagenic type (G type) prevents spermigration because of the binding of protons and creation of a dense gel network. These forms were studied with nuclear magnetic resonance (NMR) and the degree of saturation and rate of passage were determined. W 14 women treated with Conluten and 9 with Conlunett were studied with NMR during control and treatment cycles. Treatment with either drug changed the mucus from E to G type at the time of ovulation; 74% of the Conluten group and 64% of the Conlunett group showed this change. It is concluded that cervical mucus hostility to spermigration occurs during the first cycle treatment with these drugs and that this transformation is higher in cycles without ovulation. The cervical factor seems to be an effective contraceptive mechanism.

A bacterial culture was taken from the cervix in 85 sexually active women before, and 3 and 6 months after, insertion of either a copper-releasing or an inert intra-uterine contraceptive device (IUD). Sixty had a Copper-T (TCu-200) and 25 a Lippes loop D. Although in more than a quarter of the patients the bacterial flora increased slightly in diversity and abundance after IUD insertion, there was no difference in effect between the TCu-200 and Lippes loop D.85 women were examined for cervical bacterial flora before, and at 3 and 6 months after, insertion of either a Copper T (TCu-200) or Lippes loop D IUD. Bacterial flora increased slightly in diversity and abundance after insertion of an IUD in more than 25% of the subjects. However, there was no difference in effect between the TCu-200 and Lippes loop D devices.

Midcycle cerevical mucus samples from 20 fertile women with negative, and from 6 infertile women with positive serum-sperm agglutinating activity were subjected to a qualitative protein analysis by the Ouchterlony-technique, to polyacrylamide (PAA) discelectrophoresis and after purification on spermatozoa they were also run against rabbit antihuman serum in the Laurell immuno-electrophoretic technique. By the Ouchterlony method the main serum protein fractions were shown to occur also in cervical mucus. No significant differences could be found in the protein pattern of samples from fertile and infertile females as detected by polyacrylamide (PAA) electrophoresis. In all samples a split protein fraction corresponding to serum albumin and a band preceding the protein fraction corresponding to serum preablumin were observed. In 2 samples from infertile females it could be demonstrated that immunoglobulins occurring in the cervical mucus were directed towards antigenic sperm components.

The occurrence of ovulation was determined in 31 healthy women after fullterm delivery by quantitation of the serum progesterone level, (B.B.T.) basal body temperature, and cervical mucus ferning tests. B.B.T. was recorded daily beginning in the 1st week postpartum and serum progesterone estimations and cervical mucus ferning tests were performed at weekly intervals after the 1st month postpartum. All patients were followed until the 1st postpartum menstruation, and thereafter 18 women continued the study until the 2nd menstruation. The women investigated breastfed their infants for periods ranging from 1-14 weeks and ovulation during lactation occurred in none of the cases. Following weaning, when menstruation was resumed, ovulation occurred less frequently in patients who lactated for a short period as compared to those who lactated for relatively longer. When the duration of postpartum amenorrhea was short, ovulation preceded the 1st menstruation less frequently than in women with relatively longer postpartum amenorrhea. The incidence of ovulation before either the 1st or 2nd menstruation was lower in primiparae than in multiparae. None of the 12 women 25 years old or young ovulated before the menstruation while 7 ovulated before the 2nd menstruation. In women older than 25, ovulation occurred in 6 of 9 before the 1st menstruation, and in 5 of 6 before the 2nd menstration. B.B.T. and the cervical mucus ferning test were both as inadequate for ovulation detection as the serum progesterone concentration.

The sera of 70 infertile and 30 fertile couples were tested for the presence of sperm agglutinins with Kibrick's macroagglutination technique and Boyden's haemagglutination test. 15.7% of the couples studied showed the presence of sperm agglutinins (by Kibrick's method) of which 5.7% were from males and 10.0% were from females. By the haemagglutination test, 13% of the couples studied were found to possess sperm agglutinins, of which 3% were from males and 10% were from females. 30 fertile men and women studied for sperm agglutinins were found to be negative by both methods. It was also observed that these two tests detected different types of sperm agglutinins. The cervical mucus samples from 45 females (15 fertile and 30 infertile) were tested for sperm agglutinins with a mucus penetration test. 23.1, 16.5, and 57.4% of the samples from infertile females, showed 0-degree, 1-degree and 2-degree penetration respectively. In case of samples from fertile females, 6.6, 13.2 and 79.2% showed 0-degree, 1-degree and 2-degree penetration respectively. Addition of serum from infertile females to cervical mucus from the infertile female increased the 0-degree penetration percent cases to 50%, as compared with 23.1 when only cervical mucus was used. Addition of serum from fertile females, or horse serum or pure albumin or globulins did not increase the 0-degree penetration cases.

The anti-estrogenic effect of clomiphene citrate (CC) and tamoxifen (TMX) on cervical mucus was evaluated in a prospective crossover study. Ten women underwent randomized alternate cyclical treatment with either 100 mg CC, 40 mg TMX daily, or with placebo. The effect of CC, TMX and placebo on serum estradiol (E2), cervical mucus secretion and on the development of ovarian follicles was evaluated. Compared with placebo, treatment with CC and TMX significantly increased the number of mature ovarian follicles on the day of assumed ovulation (p less than 0.05), elevated E2 secretion (p less than 0.05) and decreased cervical score (p less than 0.05). It can be concluded that anti-estrogenic agents reduced the secretion of cervical mucus. However, in most cases, the excessive E2 production due to multiple follicular growth overcomes the anti-estrogenic effect.

The ultrastructure of cervical mucus has been studied by scanning (SEM) and transmission (TEM) electron microscopy. The images differ according to the methods used for preparation; different patterns were found in the same sample when the freeze-drying and critical point-drying methods were used for SEM. When using TEM, the specimen appeared more homogeneous, with fine fibrils and granules. This accords with the theory that the cervical mucus consists of a randomly entangled fibrillar network. Electron microscopy of cervical mucus requires preparation procedures which involve considerable risk of creating artefacts. In our experience the TEM technique produces fewer artefacts and therefore gives pictures more true to the in vivo situation.

The scanning electron microscope was used to study the evolution of the infrastructure of cervical mucus in normal cyclic baboons and in castrated animals treated with ovarian hormones for establishing an artificial cycle. In both groups, the results make conspicuous the progressive enlargement of the filamentous woof, which attains a maximum at midcycle and then decreases by degrees in the second part of the cycle. It was shown that the evolution of the framework is very similar during normal and artificial cycle, with only variations of slight amplitude. Moreover, the variations in the baboon mucus infrastructure closely resemble those described in the human. The results are briefly discussed in the light of known data.

(1969). The Uterine Cervix Before and After Cold-Knife Conization. Acta Obstetricia et Gynecologica Scandinavica: Vol. 48, No. 2, pp. 258-266.

This paper deals with those factors of the cervical secretion which could be evaluated quantitatively. 17 parous women were examined daily from Days 8 or 10 of the cycle until 1 or 2 days after the rise in basal body temperature. Examinations were done first in a control cycle then in a treated cycle; doses were 1 tablet of .05 mg or megestrol acetate per day. Mucus was aspirated from the cervix into a small capillary tube. PH was determined in the cervical canal by a glass electrode. Viscosity was measured by a specially designed vacuum device. Values varied markedly during the cycles. Sperm penetration into the mucus was measured by a modified Kremen technique. Dry matter and sodium and potassium content were determined. To determine ovulation pregnanediol excretion and typical changes in karyopyknotic index (KI) were determined. Treatment with megestrol acetate caused the secretion of cervical mucus to diminish but the cell count tended to increase. PH continued at about 7. Elasticity of mucus became higher during treatment particularly with the higher dose. This decreased sperm penetration. The content of dry matter was higher than in the control cycle. Sodium content of dry matter remained constant. Potassium content increased slightly with treatment possibly due to increase in cell content. The KI was below normal in treated cycles. These methods are considered needed in establishing the optimum dose of megestrol acetate.