Improvement of cervical factor with guaifenesin

[The mucus: a medium of life]

OBJECTIVES

To investigate whether mucus, with its complex structure and specific functional properties, is a medium for life?

PATIENTS AND METHODS

We compared cervical and nasal mucus samples collected from 45 ovulatory women consulting for sterility and 5 menopausal women respectively. We analyzed the physicochemical and functional characteristics. We also performed 266 sperm penetrability tests. We studied 32 samples using scanning electron microscope, according to Hexamethyl-Disilasane technique and the critical point drying method.

RESULTS

Both types of mucus had 10cm spin abilities and typical ferning patterns. The pH were similar (8.09±0.58 and 8.46±0.32 for cervical and nasal mucus, respectively) as well as the percentages of positive sperm penetration test (55.6 and 40.6 respectively). We observed similar patterns of spermatozoa mobility in both types of mucus. Under the scanning electron microscope, structures resembled woven fabric, with a stretched and rigid framework. Filaments of different diameters formed variable loose meshes. Thinner filaments linked together thicker filaments measuring between 300 and 400nm. The intermediate filaments varied between 100 and 200nm. Very thin and sparse filaments crossed the meshes, measuring between 10 to 100nm. Spermatozoa, bacteria and unspecified round cells were enmeshed in the mucus.

DISCUSSION AND CONCLUSION

From this first comparative study of nasal and cervical mucus giving the proof of sperm penetration in the both mucus and the discovery of mucus produced by archaea living in extreme conditions, we suggested that mucus, from all origins, is a medium of life.

Guaifenesin and increased sperm motility: a preliminary case report

Background

A review of the literature and an extensive Medline search revealed that this is the first case report of the use of guaifenesin to increase sperm motility.

Case

A 32-year-old male presented for an infertility evaluation. He reported an inability to conceive with his wife after 18 months of unprotected intercourse. A semen analysis was performed that included spermatozoa count, liquefaction, morphology, motility, viscosity and volume. Initial results of the semen analysis demonstrated low sperm count and motility. The provider offered treatment with guaifenesin 600 mg extended release tablets twice daily. Two months after guaifenesin therapy the semen analysis was repeated that demonstrated marked improvement in both total sperm count and motility.

Conclusion

Evidence for the effectiveness of guaifenesin is almost entirely anecdotal. Given the mechanism of action of guaifenesin, it is not clear from this case why the patient demonstrated such a large improvement in both sperm count and motility. Additional studies of the effects of guaifenesin on male fertility could yield information of the medication’s effect on men with normal or decreased total sperm counts.

Correlation of basal menses CA-125 levels and 6 month pregnancy rates in women undergoing treatments for infertility without assisted reproductive methods

PROBLEM

The objective of this study was to evaluate the correlation of menstrual CA-125 levels with pregnancy rates (PRs) after 6 months of treatment for infertility.

METHOD

The sample consisted of a heterogenous group of 160 women who sought treatment for infertility. Treatments include progesterone supplementation, donor insemination, intrauterine insemination, and ovulation induction therapy. No laparoscopies were done during the study period. A baseline CA-125 level was drawn during menses before the initiation of therapy. Patients were followed for 6 months of treatment or until a pregnancy was achieved.

RESULTS

There was no difference in the 6 month PR or viable PR by CA-125 level.

CONCLUSIONS

Elevated CA-125 levels are not predictive of poor fertility potential at least during the first 6 months of infertility therapy. Even though these higher levels sometimes suggest that endometriosis is present, the data suggest that correction of male factor, cervical factor or ovulation factor provides effective PRs without the need for laparoscopic intervention.

Effect of antisperm antibodies on postcoital results and effect of intrauterine insemination on pregnancy outcome

The effect of antisperm antibodies (ASA) in males was determined in 59 men using the direct immunobead test (IBT). Postcoital tests were evaluated in couples for whom all female factors appeared to be corrected. Pregnancy rates in 6 months were compared in couples with good postcoital tests vs. those with poor results; the latter group was treated with timed intrauterine insemination (IUI). Thirty-one percent of males with positive ASA (greater than or equal to 50%) had normal postcoital tests and all four achieved pregnancies. Fifty-six percent of men with positive ASA and poor postcoital scores achieved pregnancies following IUI therapy of their wives in 6 months; 83% of couples with normal postcoital tests achieved pregnancies as did couples treated with IUI when the postcoital was poor but the male ASA negative.

Efficacy of human menopausal gonadotropins as therapy for abnormal cervical mucus

Traditional therapies for abnormal cervical mucus, other than timed intrauterine insemination, are noteworthy for being ineffectual. Patients (n = 27) with documented abnormal Insler scores in repetitive cycles and failure to conceive with traditional treatments were screened with conjugated equine estrogens (CEE) for estrogen responsiveness of the cervix. Only 5 patients were found unresponsive. Seventeen patients with CEE-responsive cervices then were treated with human gonadotropins (hMG), initially 1 ampule days 5 to 11. If the mucus failed to improve, the hMG was increased to standard doses. Eight patients responded to 1 ampule hMG with improved mucus and conception. The remainder required 2 ampules hMG. In patient cycles with corrected cervical mucus, the viable fecundibility (fv) was 0.35. This is significantly higher than predicted for this population (fv = 0.09; P less than 0.01). In all, 14 of 17 patients conceived viable pregnancies during hMG treatment. It is concluded that graduated hMG is efficacious in treating patients with abnormal cervical mucus responsive to CEE. It is preferable to either in vitro fertilization or gamete intrafallopian transfer, based on both cost and efficacy for most patients.