Postcoital Sperm Assessment Comparative Study

This postcoital sperm assessment study was performed over a 10 month time period (November 2014-August 2015). Fifteen couples enrolled in the study. The study was a non-blinded, non-randomized, single-center comparison study comparing The Stork® OTC (Rinovum Women's Health, Monroeville, PA) to natural intercourse (NI), using the subjects as their own control/baseline. This was an efficacy study designed to compare the number of sperm in the cervical mucus following the use of The Stork OTC conception aid with the number of sperm in the cervical mucus following natural intercourse. Subjects used both The Stork OTC conception system and the natural intercourse method to evaluate concentrations of sperm in the cervical mucus. Post-coital test (PCT) data was collected demonstrating higher concentrations of sperm within the cervical mucus with The Stork OTC conception system versus natural intercourse for 85% of test subjects in this study. Of the 15 couples enrolled in the study, 2 were lost to follow-up. Mean age for male subjects was 31.7 +/ 5.4 years of age and mean age for female subjects was 29.7+/- 5.4. The average sperm score value of the 85% of test subjects with higher sperm concentrations from The Stork OTC was 3.23 times the score value of sperm concentration compared to natural intercourse. The remaining 15% of test subjects showed no change in sperm score value between The Stork OTC and natural intercourse.

[Prediction of complications of I trimester of pregnancy in women with distressed reproductive history by detection of transcervical trophoblastic cells]

The present study investigated the possibility of using trophoblastic (fetal) cells in cervical mucus of pregnant women with complicated reproductive history to predict the course of early I trimester of pregnancy. We examined 86 women at 5-6 weeks of gestation, 56 of them with normal pregnancy, 12 with missed abortion, 18 with tubal pregnancy. As a control we used 21 non-pregnant womеn with primary infertility. Trophoblastic cells we detected by immunohistochemical method and then counted. It was revealed that in the normal course of early I trimester transcervical trophoblastic cells were detected in 4 times more likely than in missed abortion and 5 times more often than in women with tubal pregnancy. In women of the control group, who never had pregnancies, trophoblastic cells were not detected. Thus, the determination of the number of transcervical trophoblastic cells can be used in the complex diagnosis of pathological course of I trimester of pregnancy in women with complicated reproductive history.

Relationship between level of serum sperm immobilizing antibody and its inhibitory effect on sperm migration through cervical mucus in immunologically infertile women

PROBLEM

Sperm immobilizing antibodies often interfere with the penetration of sperm through the cervical mucus. However, the relationship between sperm immobilizing antibody titer and the result of the post-coital test (PCT) has not yet been clarified. The aim of this study was to investigate whether the 50% sperm immobilization unit (SI50) titer, a quantitative measure of sperm immobilizing antibody, in patients' sera was correlated with the result of PCT.

METHOD OF STUDY

The sperm immobilization test (SIT) was performed for 2834 infertile women in two university hospitals. The SI50 titers were evaluated by quantitative SIT. In some cases with sperm immobilizing antibody, PCT was carried out before ovulation and assessed according to the criteria of World Health Organization (1992). Infertile couples with abnormal semen characteristics were excluded.

RESULTS

Seventy-four of 2834 women had sperm immobilizing antibodies in their sera, giving a positive rate of 2.6%. Twenty-four (77.4%) of 31 women with sperm immobilizing antibodies and 28 (20.4%) of 137 women without the antibody had abnormal PCT results. There was a significant difference between the two groups (P<0.0001). When patients with sperm immobilizing antibodies were divided into two groups according to the SI50 titers, the abnormal result of PCT was obtained in all 10 patients with high (>10) SI50 titers, while that was 14 (66.7%) in 21 patients with low (10) SI50 titers. There was a significant difference between the two groups (P=0.04).

CONCLUSION

The SI50 titer in the serum can predict inhibitory effects on sperm migration through cervical mucus in immunologically infertile women. Evaluation of the SI50 titers in patients' sera seems to be useful for decision-making in infertile women with sperm immobilizing antibodies regarding whether they have the possibility of conceiving by timed intercourse.

[Cytological screening--the technique of cytological specimen taking and its influence on the quality of the method]

The aim of our research work was to evaluate if the way of taking material influence the quality of the Pap smear test. 2300 patients were examined by taking Pap smear test for 7 years period from 2000 till 2007. In 1000 patients endocervical brush /Cytobrush/ was used and after that Ayre spatula for taking ectocervical material. In 1300 patients Ayre spatula was used first and after that endocervical brush applied. The number of the Pap smears contaminated with blood, the Pap smears without endocervical component and the Pap smears with bad fixation were examined. There were more contaminated with blood pap smears in the group where endocervical brush was used first /156 patients vs 100, p = 0.004/. There was no significant difference in the number of bad fixated pap smears, the "thick" pap smears, the inflamated Pap smears in both groups. The quality of the technique for taking pap smears when Ayre spatula is used first and after that endocervical brush is better than the reverse way of obtaining cytological material from the cervix. With this technique we find more squamous intraepithelial lesions.

Impact of estrous synchronization methods on cellular proportions in cervical mucus and serum hormone concentrations

The objective of this study was to examine cytological changes of cervical mucus following the induction of estrus with intra-vaginal drug release (CIDR) devices in dairy cows. Sixty healthy Holstein Frisian cows, averaging 80 (+/-10) days post-partum, were selected from a commercial dairy farm around Shiraz. Cows in the control group were synchronized by the Ovsynch protocol. Cows in the second group (OV+CIDR) were subjected to the same Ovsynch protocol but in addition were administered a progesterone-releasing CIDR. Cows in the third group (OV+S-CIDR) were subjected to Ovsynch procedures but received the skeleton of a CIDR device, which did not release progesterone. Cows in the fourth group (E2+CIDR) received a progesterone releasing CIDR but were injected with estradiol benzoate. Cows in group 5 (E2+S-CIDR) received a CIDR skeleton and estrodial benzoate. CIDR devices were removed from cows in groups 2-4 and all cows were injected with PGF2alpha on day -3. Blood samples and cervical mucus discharges were collected from all cows on days -10, -3, 0 and 12 relative to AI. On the day of AI, the mean+/-S.D. percentage of neutrophils was significantly higher (p<0.05) in the S-CIDR+OV and S-CIDR+E2 groups than in Ovsynch group. Comparing the percentage of neutrophils in cervical mucus of Ovsynch group (less than 1%) with that of other treatment groups on the day of AI (from 5 to 39%) revealed the influential effect of a CIDR device on the reproductive tract. Results of the current study did not reveal hormonal effects but did identify mechanical effects of CIDRs on cell percentages in cervical mucus. The hormonal effects were probably masked by mechanical effects. Therefore, we were not able to confirm hormonal effects on proportions of different cells in cervical mucus. Consequently, additional research on hormonal effects and the mechanical effects of CIDR on the uterus is required.

[Low-intensity laser effects on local immunity of female reproductive system affected with chlamidia infection]

Low-intensity laser impact on the main effector functions of the cervical secretion neutrophils in females suffering from Chlamidia infection has been studied. Dysfunction of neutrophil granulocytes of the cervical secretion was revealed. This manifested in the decreased number of phagocytes and lower rates of phagocytosis. The study of cervical secretion neutrophils has found that the content of active intracellular forms of oxygen was decreased in patients compared to healthy subjects. Low-intensity laser stimulated not only phagocytosis but also intracellular generation of active oxygen forms. Thus, low-intensity laser eliminates dysfunction of cervical secretion neutrophils.

Preliminary report: Correct diagnosis of sex in fetal cells isolated from cervical mucus during early pregnancy

The aim of this study was to determine the accuracy of sexing fetal cells isolated from cervical mucus. Immunopositive cells identified using a fetal-specific antibody were isolated and subjected to genetic analysis. Fetal sex was predicted in all 22 samples, as confirmed by analysis of the corresponding placental tissue. This study validates the accuracy of our test for sex diagnosis and confirms the ability to effectively recover and analyse fetal cells from the cervical mucus during early pregnancy.

Detection of fetal cells from transcervical mucus plug before first-trimester termination of pregnancy by cytokeratin-7 immunohistochemistry

AIM

The presence of fetal cells in the endocervical mucus of pregnant women was first reported in 1971. The uterine cavity is patent during the first trimester prior to fusion of amnion and chorion. Fetal cells from degenerating chorion frondosum are theoretically shed into the uterine cavity between seven and 13 weeks' gestation and are trapped in the transcervical mucus; they can be identified by immunohistochemistry.

METHOD

Ninety-nine transcervical mucosal plugs from pregnant women of between 7 and 13 weeks before abortion were collected, fixed, embedded, sectioned and stained with monoclonal antibody of cytokeratin-7 (CK-7) by immunohistochemistry.

RESULT

The identification of trophoblasts on each slide was defined according to positive staining and histologically chorionic villous similarity under microscopic examination, using the following five categories: none (1), less than five single positive-stained cells per-section (2), more than five single positive-stained cells per-section (3), clumps of positive-stained cells (4), and histological-like intact or fragmented chorionic villi (5). From amongst 71 samples that qualified for analysis, individual slides were evaluated and categorized into three groups, with the following results: 32 (45.1%) fell into group 1 (category 1) denoting a negative result, 10 (14.1%) fell into group 2 (category 2) indicating a possible positive result and 29 (40.8%) fell into group 3 (any combination of categories 3-5) representing a positive result.

CONCLUSIONS

Fetal cells, identified by CK-7, can be found in more than 59.2% of the transcervical mucus in early pregnancy by use of a minimally invasive sampling method. Prenatal diagnosis of single-gene or chromosome disorders may be possible in the pregnant transcervical mucus by use of modern molecular methods and they deserve further study.

Ultrastructure of the human periovulatory cervical mucus

Two main types of cervical mucus have been described during the menstrual cycle: oestrogenic and progestative. Each category shows diverse morphological and functional features from the reproductive point of view. Traditionally, this change has been approached by analysing morphological patterns. In fact, a mesh model has been described for cervical mucus, structurally composed of fibrillar subunits with a parallel orientation, together with another model in a characteristic network shape with canalicular units, but the real model is not clear. The objective of our work was to study the different morphological structures of the mucus, as related to the day of follicular rupture (considered as day 0) determined by ultrasound. Cervical mucus samples were obtained from the cervical canal with an ASPIRETTEtrade mark from day -4 to day +1 of the menstrual cycle. Samples were fixed and dried by critical point. The ultrastructure was examined with scanning electron microscopy. The presence of three types of oestrogenic and one type of progestative cervical mucus was confirmed in this period. Our paper shows different types of ultrastructure in the oestrogenic mucus in relation to ovulation, which would help to understand the interaction between male gametes and cervical mucus in migration through the female genital tract.

Immunoglobulin levels and phagocytes in the cervical mucus plug at term of pregnancy

BACKGROUND

To characterize the potential for adaptive immune protection in cervical mucus plugs with respect to immunoglobulin isotypes and effector cells (phagocytes).

METHODS

Thirty-one cervical mucus plugs were collected from healthy women in labor at term. The cervical mucus plugs were allocated either to analysis of immunoglobulins by enzyme-linked immunosorbent assay (ELISA), gel chromatography and Western blotting (n = 20) or to microscopical, including immunocytochemical, analyses. The levels of immunoglobulin in the plugs were compared to the levels in 10 samples of ovulatory cervical mucus from nonpregnant women.

RESULTS

In the cervical mucus plugs, levels of immunoglobulin G (IgG) [median 3270 microg/mL (100-14 500)] and IgA [540 (22-2820)], but not IgM [30.5 (1.0-160)], were significantly elevated compared to cervical mucus from nonpregnant women (p < 0.02 for IgG and IgA). The IgG : IgA ratio in the plugs was also elevated (p < 0.02). The proportion of secretory immunoglobulin A (SIgA) relative to total IgA in the plugs ranged from 16 to 65% (n = 5). IgA and IgG were largely intact. Microscopically, the vagina-proximal part of the cervical mucus plugs contained bacteria and was rich in cells, mainly phagocytes. Conversely, the uterine part contained few cells.

CONCLUSION

The high immunoglobulin levels in combination with the presence of phagocytes suggest a potential for adaptive immune defense in the cervical mucus plug, which, together with innate immune factors, may act as an immunological gatekeeper protecting the fetomaternal unit against infection from the vagina.

DNA identification of fetal cells isolated from cervical mucus: potential for early non-invasive prenatal diagnosis

OBJECTIVES

To develop a reliable method to isolate fetal cells for genetic diagnosis.

DESIGN

Aspiration of cervical mucus from pregnant women in the first trimester.

SETTING

Pregnant women were recruited before an elective termination of pregnancy.

POPULATION

Sixty pregnant women (7-10 weeks of gestation).

METHODS

Fetal cells were isolated from aspirated cervical mucus of pregnant women using a combination of enzymatic digestion, fluorescent immunohistochemistry, micromanipulation and single-cell DNA allelic profiling.

MAIN OUTCOME MEASURES

The isolation and identification of fetal cells.

RESULTS

The transformation of the tenacious cervical mucus into a single-cell suspension enabled the isolation and identification of fetal cells by fluorescent immunohistochemistry. Confirmation of fetal origin was accomplished by single-cell DNA allelic profiling alongside known maternal cells.

CONCLUSIONS

This novel non-invasive method is rapid and efficient with results attainable within 24 hours as early as seven weeks of gestation. The technique would offer earlier reassurance and the option of first trimester therapeutic abortions to both high and low risk pregnant women.

A phase I comparative postcoital testing study of three concentrations of C31G

BACKGROUND

C31G is a broad-spectrum antibacterial agent that shows contraceptive properties in vitro. This postcoital testing study evaluated the ability of three C31G concentrations, 0.5%, 1.0% and 1.7%, administered as a 3.5-mL dose of a vaginal gel to prevent sperm from entering mid-cycle cervical mucus. Irritation of the genitalia and acceptability were also assessed.

METHOD

At baseline, a mid-cycle cervical mucus test and a postcoital test were performed within 24 h of each other without use of any study products to establish normal mid-cycle cervical mucus and sperm penetration. Subjects then completed up to three test cycles using one of the three concentrations of study product during intercourse.

RESULTS

Twenty-two of the 61 women enrolled completed a baseline cycle and at least one test cycle. An average of 14.6 progressively motile sperm per high power field was seen at baseline. This was reduced to 0.3 after use of 0.5% C31G, 0.5 after use of 1.0% C31G, and 0.4 after use of 1.7% C31G. There was no significant difference between test products (p >/= 1.000) but each test product was significantly different from baseline (p < 0.002). Very little genital irritation was observed. There were more reports of leakage and messiness with increasing C31G concentration.

CONCLUSION

This study suggests that all three concentrations of C31G are likely to give reasonable results in a contraceptive effectiveness trial. Based on the results of this and other trials, the 1.0% concentration has been selected for further development, including Phase III trials of contraceptive effectiveness.

Fetal cells in cervical mucus in the first trimester of pregnancy

OBJECTIVES

The aim of this study was to first evaluate the presence of fetal cells in cervical mucus samples collected in the first trimester of pregnancy and then to compare different laboratory methods for the detection of these cells.

METHODS

Mucus samples were collected by using a cytobrush before termination of pregnancy (TOP) from 143 pregnant women between 7 and 12 weeks of gestation. None of the women had undergone an invasive diagnostic procedure prior to cervical mucus sampling. Samples of placental tissue were collected from each patient at TOP. Slides from each sample were first observed under an inverted microscope to detect possible sperm contamination. In the first part of our experiments, 40 mucus samples were treated with a mucolytic solution containing N-acetylcysteine (AC) and were analysed by a polymerase chain reaction (PCR) assay. The second series, consisting of 71 mucus samples, was treated with a mucolytic solution containing dithiothreitol (DTT): all 71 samples were analysed by a PCR-based assay, and an aliquot for fluorescent in situ hybridisation (FISH) analysis was also obtained from 48 out of 71 samples. In the third part of our experiments, performed on 32 mucus samples, mucus trapped on the cytobrush was directly spread on two slides for FISH analysis without any mucolytic treatment. All placental tissue samples obtained at termination were analysed by FISH for fetal sexing.

RESULTS

Overall, the use of PCR-based or FISH analyses on 143 mucus samples resulted in correct sex prediction in 92/143 (64.3%) samples [20/66 (30.3%) cases from known male pregnancies and 72/77 (93.5%) cases from known female pregnancies]. In the AC group, Y-derived sequences were found in 7/23 samples (30.4%) from known male pregnancies and in 1/17 cases from known female pregnancies, with an overall correct sex prediction in 23/40 cases (57.5%). In the DTT group, Y-derived sequences could be amplified in 10/30 samples (33.3%) from known male pregnancies and in 4/41 cases from known female pregnancies, with an overall correct sex prediction in 47/71 cases (66.2%). In the DTT samples analysed by FISH, nuclei bearing XY signals were detected in 5/26 (19.2%) cases from known male pregnancies and in none from female pregnancies, the rate of correct sex prediction being 56.2% (27/48). On untreated mucus samples analysed by FISH, nuclei with XY signals were documented in 3/13 (23%) samples from male conceptuses and in none from known female pregnancies, with an overall correct sex prediction in 22/32 cases (68.7%).

CONCLUSION

Fetal cells were not detected in a constant and reliable fashion in cervical mucus samples collected in the first trimester of pregnancy. The detection rate was poorly influenced by the use of different laboratory methods. This sampling technique cannot be regarded as a promising tool towards minimally invasive prenatal diagnosis.

In vitro and in vivo assessment of functional capacity of flow cytometrically sorted ram spermatozoa after freezing and thawing

The effect of sex sorting and freeze–thawing on the viability and fertility of ram spermatozoa was investigated in the present study. Non-sorted (control) frozen–thawed spermatozoa had a higher motility and forwards progressive motility (FPM) than sorted frozen–thawed spermatozoa (60.9 ± 2.9% v. 57.0 ± 3.3% and 4.0 ± 0.1 v. 3.5 ± 0.1 FPM, respectively; P < 0.001) after incubation (6 h at 37°C). Sorted and non-sorted (control) frozen–thawed spermatozoa had similar acrosome integrity (73.7 ± 1.8% v. 75.2 ± 2.1%, respectively) after thawing and incubation. A greater proportion of sorted spermatozoa displayed chlortetracycline staining patterns that were characteristic of capacitation (22.0 ± 2.8%; P < 0.05) than non-sorted (control) spermatozoa (15.4 ± 2.6% B pattern) before freezing. Overall, more sorted frozen–thawed spermatozoa showed patterns characteristic of being acrosome reacted (12.8 ± 0.7%; P < 0.01) and less were uncapacitated (35.5 ± 0.6%; P < 0.05) than non-sorted (control) frozen–thawed spermatozoa (7.7 ± 0.8% and 38.6 ± 0.6% for AR and F pattern, respectively). Similar numbers of non-sorted (control) and sorted frozen–thawed spermatozoa migrated through artificial cervical mucus after 1 h (76.4 ± 11.9 v. 73.9 ± 11.9 spermatozoa, respectively). The distance travelled by the vanguard spermatozoon was also similar (56.9 ± 7.8 v. 38.6 ± 5.8 mm for control and sorted spermatozoa, respectively). Sorted and control frozen–thawed spermatozoa displayed a similar pattern of binding to, and release from, an oviduct epithelial cell monolayer (OECM), but sorted frozen–thawed spermatozoa were released more rapidly (P < 0.05) than non-sorted (control) frozen–thawed spermatozoa. The pregnancy rate was higher for ewes inseminated with 100 × 106 (commercial control) frozen–thawed spermatozoa (59%) than for 5, 10, 20 and 40 × 106 total sorted frozen–thawed spermatozoa (41% overall; P < 0.001). Insemination of 16 × 106 resulted in a higher pregnancy rate (31%) than 106 (17%; P < 0.05), but was similar to ewes that received 4 × 106 sorted frozen–thawed spermatozoa (24%). Time of insemination (54, 58 and 62 h after sponge removal) had no effect on pregnancy rate. Pregnancy in gonadotrophin-releasing hormone-treated ewes was affected by insemination dose (P < 0.05) but not sperm type (sorted and non-sorted) or ram. Pregnancy was higher after insemination of 40 × 106 than 5 or 20 × 106 non-sorted (control) or sorted frozen–thawed spermatozoa (70%, 33% and 35%, respectively; P < 0.05). Sorted frozen–thawed spermatozoa may have a shorter viability within the female tract than non-sorted frozen–thawed spermatozoa.

Determination of the estrous cycle phases of rats: some helpful considerations

The short length of the estrous cycle of rats makes them ideal for investigation of changes occurring during the reproductive cycle. The estrous cycle lasts four days and is characterized as: proestrus, estrus, metestrus and diestrus, which may be determined according to the cell types observed in the vaginal smear. Since the collection of vaginal secretion and the use of stained material generally takes some time, the aim of the present work was to provide researchers with some helpful considerations about the determination of the rat estrous cycle phases in a fast and practical way. Vaginal secretion of thirty female rats was collected every morning during a month and unstained native material was observed using the microscope without the aid of the condenser lens. Using the 10 x objective lens, it was easier to analyze the proportion among the three cellular types, which are present in the vaginal smear. Using the 40 x objective lens, it is easier to recognize each one of these cellular types. The collection of vaginal lavage from the animals, the observation of the material, in the microscope, and the determination of the estrous cycle phase of all the thirty female rats took 15-20 minutes.

Effects of different temperatures for drying cervical mucus smear on their crystallisation pattern: a short report

The effects of different room temperatures for drying cervical mucus on crystallisation of fern-tree patterns was determined using cervical mucus smears from 60 women undergoing investigation for infertility at the University of Benin Teaching Hospital. Cervical mucus smears were dried in the oven at 15, 20, 25, 30 and 35 degrees C and examined rapidly for fern-tree crystallisation patterns decreased significantly in proportion (p < 0.05); they became atypical or were not formed at all. The finding in this study demonstrates that in tropical environments where ambient room temperature may reach 35 degrees C, fern-tree pattern would differ from those in temperate regions.

Diffusion of macromolecules and virus-like particles in human cervical mucus

To determine whether or not large macromolecules and viruses can diffuse through mucus, we observed the motion of proteins, microspheres, and viruses in fresh samples of human cervical mucus using fluorescent recovery after photobleaching and multiple image photography. Two capsid virus-like particles, human papilloma virus (55 nm, approximately 20,000 kDa) and Norwalk virus (38 nm, approximately 10,000 kDa), as well as most of the globular proteins tested (15-650 kDa) diffused as rapidly in mucus as in saline. Electron microscopy of cervical mucus confirmed that the mesh spacing between mucin fibers is large enough (20-200 nm) for small viruses to diffuse essentially unhindered through mucus. In contrast, herpes simplex virus (180 nm) colocalized with strands of thick mucus, suggesting that herpes simplex virus, unlike the capsid virus particles, makes low-affinity bonds with mucins. Polystyrene microspheres (59-1000 nm) bound more tightly to mucins, bundling them into thick cables. Although immunoglobulins are too small to be slowed by the mesh spacing between mucins, diffusion by IgM was slowed by mucus. Diffusion by IgM-Fc(5 mu), the Fc pentamer core of an IgM with all 10 Fab moieties removed, was comparably slowed by mucus. This suggests that the Fc moieties of antibodies make low-affinity bonds with mucins.

The Amount of MUC5B mucin in cervical mucus peaks at midcycle

The physical character and amount of mucus secreted by the endocervix changes dramatically during the menstrual cycle to facilitate sperm migration at the time of midcycle ovulation. Mucins are highly glycosylated, high-molecular-weight proteins, which are the major structural components of the protective mucus gel covering all wet-surfaced epithelia, including that of the endocervix. We have previously demonstrated that the endocervical epithelium expresses messenger RNA (mRNA) of three of the large gel-forming mucins, designated MUC5AC, MUC5B, and MUC6, with mRNA of MUC5B predominating. Because mucin protein levels may be regulated posttranscriptionally, measurement of MUC5B protein levels with cycle are needed for correlation to mRNA levels. Measurement of specific mucin gene products within mucus secretions has been limited by availability of specific, well-characterized antibodies and by volume requirements of the isolation protocols for mucins, which include CsCl density centrifugation and fraction isolation. To measure MUC5B protein within the cervical mucus through the hormone cycle, we developed a polyclonal antibody specific to the mucin. The antibody, designated no. 799, is to a synthetic peptide mimicking a 19-amino-acid segment of an intercysteine-rich region within the D4 domain in the 3' region of the MUC5B protein. It recognizes native as well as denatured MUC5B on immunoblot, is preadsorbable with its peptide, and binds to apical secretory vesicles of epithelia expressing MUC5B. We used the MUC5B antibody along with a cervical mucin standard cervical mucin isolate in enzyme-linked immunosorbent assay to determine the relative amount of MUC5B mucin in samples of human cervical mucus taken through the menstrual cycle. We demonstrate a peak of MUC5B mucin in human cervical mucus collected at midcycle, compared with mucus from early or late in the cycle. This peak in MUC5B content coincides with the change in mucus character that occurs at midcycle, suggesting that this large mucin species may be important to sperm transit to the uterus.

Transcervical sampling as a means of detection of fetal cells during the first trimester of pregnancy

OBJECTIVE

Our aim was to evaluate the detection of fetal cells from transcervical samples by means of fluorescence in situ hybridization analysis.

STUDY DESIGN

Forty-seven women undergoing first-trimester termination of pregnancy were recruited for transcervical sampling and 16 were recruited for endocervical mucus aspiration. Subjects were asked to assess the discomfort of the procedure. Fluorescence in situ hybridization analyses were performed with X and Y chromosome-specific probes. Results were compared with those of conventional chromosomal analysis.

RESULTS

Male signals (XY) were observed in 19 of 25 male fetuses (76%), and female signals (XX) were observed in 21 of 22 female fetuses. There was a significant variation between operators in cell retrieval. With mucus aspiration only 37.5% of male fetuses were correctly identified. The subjects did not find the procedure uncomfortable and reported that it was comparable to having a cervical smear taken.

CONCLUSIONS

Transcervical irrigation correctly identified the sex of 76% of male fetuses, but it still has considerable operator variability. This variability might be reduced by improved catheter design.

Fetal cells in cervical mucus and maternal blood

Research in developing effective and accurate methods for non-invasive prenatal diagnosis has focused on two main techniques: the retrieval of trophoblast cells from the cervix and the enrichment of fetal erythroblasts from the blood of pregnant women. The isolation of fetal cells by both approaches has permitted the identification of fetal aneuploidies by the use of fluorescence in-situ hybridization (FISH) with appropriate probes, as well as fetal single gene disorders by polymerase chain reaction (PCR). In the latter instance, it has been shown that in order to attain the high degree of specificity required for prenatal diagnosis, it is necessary to analyse single fetal cells isolated by micromanipulation. This practice has permitted the successful characterization of fetal rhesus status, haemoglobinopathies, Duchenné's muscular dystrophy and spinal muscular atrophy, amongst others.Further developments include investigations into whether the diagnostic potential of fetal cells retrieved by either method can be expanded by the possible culturing of such cells, as well as the possibility of performing successive rounds of FISH and PCR by the recycling of isolated fetal cells.A novel observation that our group has made is that the traffic of fetal cells is enhanced in pregnancies affected by the pregnancy related disorder, pre-eclampsia. Our subsequent investigations have shown that this elevation in fetal cell traffic may serve as an early marker for those pregnancies at risk for this disorder.A very recent exciting discovery has been that free extracellular fetal DNA can be detected in the plasma and serum of pregnant women, which may permit the rapid and accurate detection of uniquely fetal loci, such as the fetal rhesus D gene in rhesus D negative pregnant women.

Minimal requirements for a successful outcome in anovulatory patients treated with human menopausal gonadotropins

OBJECTIVE

To determine the minimal requirements for achieving a full-term singleton pregnancy in hMG-treated patients.

METHODS

One hundred and ninety-two pregnancy cycles resulting from hMG therapy in infertile patients were retrospectively studied to determine the minimal requirements for the occurrence of a pregnancy in those women. The cycles were divided into five groups: pregnancies ending in miscarriage, ectopic pregnancies, pregnancies ending in preterm delivery, full-term singleton pregnancies, and full-term multiple pregnancies. The number of hMG ampules, the number of preovulatory follicles reaching 18 mm or more in diameter, the cervical mucus score (Insler), the number of living spermatozoa per high-power field (HPF) observed in the cervical mucus on the day of hCG administration, and the midluteal plasma progesterone concentration were determined and correlated with the outcome of the pregnancy in the five groups studied. The minimal requirements for the occurrence of a full-term singleton pregnancy were also determined.

RESULTS

In this cohort of 192 women, the mean number of hMG ampules administered was 25.38 (1903.5 IU), the mean number of preovulatory follicles reaching 18 mm was 2.1, the mean cervical mucus score (Insler) was 9.48, and the mean number of motile spermatozoa per HPF in the cervical mucus on the day of hCG administration was 19.3. There were no statistically significant differences between the five groups studied regarding these four variables. The mean midluteal plasma progesterone concentration was 29.07 ng/mL and there was no statistically significant difference in midluteal plasma progesterone concentration between the cycles resulting in full-term deliveries and those ending in miscarriage. However, a statistically significant difference in midluteal plasma progesterone concentration was found between the cycles resulting in full-term singleton pregnancies and those resulting in full-term multiple pregnancies.

CONCLUSIONS

The minimal requirements for achieving a full-term singleton pregnancy were 9 ampules of hMG (675 IU), one 18-mm follicle, a cervical mucus score (Insler) of 6 on the day of hCG administration, and a midluteal plasma progesterone concentration of 10.83 ng/mL. The presence of motile spermatozoa in the cervical mucus was a reassuring sign in 92.7% of instances but was not an absolute necessity for a successful outcome.

[The postcoital test: clinico-laboratory observations]

The choice of optimal time, the technique and limitations of the post-coital test (PCT) have been described. They are of important significance for getting reliable information both concerning the cervical mucus, quality and migration of spermatozoa in female genital tract. It has been stressed that a negative PCT does not necessary exclude pregnancy. There are shown data for prognostic value of the PCT. The observation of more than 20 motility spermatozoa per HPF and higher frequency of pregnancy is common finding in comparison to low motility and number of spermatozoa in cervical mucus. The data support the hypothesis of "filtering" mechanism, excluding entrance of abnormal spermatozoa. Observing "shaking" phenomenon directs to searching immunological factor (local or systemic) against male gametes.

Intraperitoneal insemination and retrograde sperm transport in dairy cows

To examine the efficiency of retrograde sperm transport following intraperitoneal insemination, live and dead spermatozoa were used at different concentrations, and sperm recovery from cervical mucus (0.5 ml) 2, 6, 12 and 24 h following insemination was evaluated. Forty lactating Friesian cows, in their second to fourth lactation period, were used in this experiment. Thirty-six cows received intraperitoneally either live or dead spermatozoa. Each group of six cows received one of three total sperm numbers of 30, 45 and 90 million. Four cows were inseminated with 90 million spermatozoa into the uterus and served as a control group. All cows were inseminated towards the end of oestrus. After intrauterine insemination sperm recovery declined, but motile and/or immotile spermatozoa were recovered from all cows at any time. In cows inseminated intraperitoneally, sperm was recovered from the cervix at 6-24 h when 90 million were inseminated. A greater number of spermatozoa was recovered after dead rather than after live sperm inseminations. Only immotile, intact or broken spermatozoa and tail-less heads were recovered after intraperitioneal insemination using either live or dead spermatozoa. No sperm was recovered for 30 and 45 million inseminations. Our results show that, following intraperitoneal insemination, there is passive sperm transport from the peritoneal cavity to the genital tract close to the time of ovulation, and suggest a higher sperm retention in the genital tract when live as opposed to dead spermatozoa are used.

Interleukin-8 levels and granulocyte counts in cervical mucus during pregnancy

PROBLEM

We measured interleukin-8 (IL-8) and granulocyte counts in cervical mucus to assess local immunity and parturition.

METHOD OF STUDY

We detected IL-8 by enzyme linked immunosorbent assay (ELISA) and Western blotting. Granulocytes were counted on a slide glass containing mucus from the external cervical os.

RESULTS

ELISA and Western blotting revealed IL-8 in cervical mucus from both nonpregnant and pregnant women. There were no significant differences in cervical mucus IL-8 levels or granulocyte counts between follicular, ovulatory, and luteal phases. However, IL-8 and granulocyte counts were significantly decreased after menopause. IL-8 and granulocyte counts were increased significantly during pregnancy, and were further increased after 38 weeks of gestation and at labor. IL-8 levels were significantly correlated with granulocyte counts, based on the study of 678 samples (P <0.0001).

CONCLUSION

IL-8 is involved in the increase of cervical granulocytes and in the process of parturition.

Secretory leukocyte protease inhibitor (SLPI) concentrations in cervical mucus of women with normal menstrual cycle

Secretory leukocyte protease inhibitor (SLPI) is a potent inhibitor of human leukocyte elastase. SLPI transcripts in the cervical tissue were detected during the menstrual cycle by reverse transcription-polymerase chain reaction (RT-PCR). Western blot analysis revealed that the intensity of SLPI protein in cervical tissue in the ovulatory phase was stronger than in other phases. Immunohistochemistry using an anti-SLPI polyclonal antibody revealed positive staining in the epithelial cells of the endocervix. Western blot analysis also revealed that SLPI protein was present in the cervical mucus. Again the intensity of SLPI protein in the ovulatory phase was stronger than that in the follicular phase. The SLPI concentrations and SLPI/elastase ratios in the cervical mucus of women in the ovulatory phase were significantly higher than in the follicular and luteal phases. The SLPI and elastase concentrations in the cervical mucus were positively correlated. No significant difference was found in the SLPI serum concentrations of women during the menstrual cycle. These results suggest that production of SLPI from cervical epithelial cells during the ovulatory phase may be important for protection from the effects of elastase.

Analysis of fetal sex in TCC sample DNA: a contribution to the validation of this approach

We compared two methods of collection of transcervical cell samples, mucus aspiration and cytobrush, with respect to the efficiency in determining fetal sex and we correlated the results with the week of gestation (7-11 weeks) to evaluate if the age of gestation influenced the success of the analysis. DNA extracted from TCC samples recovered by mucus aspiration (n = 27) and cytobrush (n = 36) were analysed by nested PCR to predict fetal sex. The statistical indices of sensitivity, specificity, positive predictive value and negative predictive value were determined, and compared with those of other studies previously performed. No statistically significant difference was found between the two methods of TCC sampling concerning the success of fetal sex prediction which was high for both methods (78 per cent and 89 per cent) and no correlation with the week of gestation was found. Transcervical cell sampling represents an encouraging prospect for first-trimester prenatal diagnosis even when the least invasive techniques are used.

A phase I study of Femcap used with and without spermicide. Postcoital testing

The objectives of the study were to assess the ability of the Femcap, a new vaginal contraceptive device made of silicone and designed to fit snugly around the cervix to prevent the penetration of sperm into midcycle cervical mucus when used with and without spermicide; and to compare it with the standard contraceptive diaphragm used with spermicide. Eight women underwent two baseline cycles of postcoital testing in which no device was used, followed by three test cycles in which Femcap with spermicide, Femcap with nonspermicidal lubricant (K'Y gel) or the Ortho All-Flex diaphragm with spermicide was used. The sequence of testing cycles was randomized. In each cycle, condoms were used prior to midcycle, then a midcycle cervical mucus specimen was examined to ensure midcycle characteristics and the absence of sperm. Each woman then had intercourse using either no device (baseline cycles) or the prescribed device (test cycles) and returned 2-3 h afterwards. Cervical mucus was again assessed for adequacy and the presence of spermatozoa. The average number of progressively motile sperm seen per high power field was as follows: first baseline cycle, 18.0; second baseline cycle, 17.8; test cycle with Femcap used with nonspermicidal lubricant, 0.1; test cycle with Femcap used with spermicide, 0.2; and test cycle with the diaphragm used with spermicide, 0.0. There was no significant difference between baseline cycles or among test cycles in the average number of progressively motile sperm seen (p > 0.05). The average number of progressively motile sperm seen in each test cycle did, however, differ significantly from the average number seen in either baseline cycle (p < 0.05). Femcap, used with either a spermicidal lubricant or a nonspermicidal lubricant, appears to be comparable with the diaphragm used with spermicide in preventing sperm from entering midcycle cervical mucus.

A phase I comparative study of three contraceptive vaginal films containing nonoxynol-9. Postcoital testing and colposcopy

The objectives of this study were 1) to assess the ability of a new contraceptive vaginal film containing two doses of nonoxynol-9 (N-9) to prevent the penetration of sperm into midcycle cervical mucus, and 2) to determine the effect of the film on the vaginal epithelium. The novel formulation was compared with VCF (a currently marketed film also containing N-9). Ten women underwent two baseline cycles of postcoital testing in which no film was used, followed by three test cycles in which Allendale-N9 film, a new film containing either 100 or 130 mg N-9, or VCF containing 70mg N-9 was used. The sequence of testing cycles was randomized. In each cycle, condoms were used prior to midcycle, then a midcycle cervical mucus specimen was examined to ensure midcycle characteristics and the absence of sperm. Each woman then had intercourse using either no film (baseline cycles) or a test film (test cycles) and returned 2-3 h afterwards. Cervical mucus was again assessed for adequacy and the presence of sperm. Each woman also underwent colposcopy using a protocol developed by the World Health Organization. The average number of progressively motile sperm seen per high power field were as follows: average of the two baseline cycles, 19.3; test cycle with Allendale-N9 film containing 100 mg N-9, 0.6; test cycle with Allendale-N9 film containing 130 mg N-9, 0.9; and test cycle with VCF, 0.5. There was no significant difference between baseline cycles or between test cycles in the number of progressively motile sperm per high power field (HPF) seen (p = 0.31 and p > or = 0.50, respectively). The average number of motile sperm seen in each test cycle did, however, differ significantly from the number in either baseline cycle (p < 0.02). The majority of colposcopic examinations were normal. In one baseline cycle and eight test cycles, colposcopy showed superficial de-epithelialization without underlying inflammation. There was no apparent dose response and in all cases the volunteers were asymptomatic. A vaginal contraceptive containing either 100 or 130 mg N-9 in a new film base appears to be safe and comparable to VCF in preventing sperm from entering midcycle cervical mucus.

Alteration of human sperm kinematics in cervical mucus due to nonoxynol-9

Traditional endpoints of the double-ended test (DET), a contraceptive screening assay used to evaluate the ability of a compound to permeate cervical mucus and inhibit sperm progression, ignore important information about sublethal effects upon sperm cells. Improved contraceptive agents may capitalize on such sublethal aspects. This study utilized a DET testing protocol that included measurement of human sperm motion characteristics as an indicator of cell function within spermicide-exposed human mucus. The currently available spermicide nonoxynol-9 (N9) was used as the test compound and was dissolved in two different delivery solutions, deionized (DI) water and saline, to evaluate the effects of the osmolarity and pH of the delivery vehicle on test results. The N9-water treatment demonstrated significantly greater activity than the N9-saline treatment in terms of all measured variables, exhibiting an apparent "biopermeation" distance approximately 3 mm further into the mucus. The DI water control treatment displayed less activity than N9-saline in terms of the vanguard penetration distance, but comparable or greater activity in terms of inhibiting kinematic variables. The saline control treatment had no effect in terms of any measured variable. Dose responses to N9 of sperm in mucus were inferred from DET results combined with direct measures of N9 diffusion. These were compared to dose responses to N9 of seminal sperm, indicating that N9 inhibits sperm motion at lower concentrations in mucus than in semen.

Migration of foreign lymphocytes from the mouse vagina into the cervicovaginal mucosa and to the iliac lymph nodes

The mode of heterosexual transmission of human immunodeficiency virus (HIV) is not yet understood. The semen of HIV-infected men contains free virus and infected cells, and it is not known which of these is more important for sexual transmission of the virus to women. Some investigators have presented in vitro studies supporting a cellular mode of transmission of HIV and have suggested that infected lymphoid cells may act as the primary source of infection. This has become known as the "Trojan Horse" hypothesis. In vivo demonstrations of such events are lacking and are not likely to be forthcoming using human subjects. To investigate the ability of normal lymphoid cells to invade the cervicovaginal mucosa in an experimental animal, we stained C3H/He (H-2Kk) mouse peritoneal lymphoid cells with bisbenzimide, a vital fluorescent DNA-binding dye, and inoculated the cells atraumatically into the vaginas of progestin-treated, BALB/c (H-2Kd) recipient mice. Donor cells were identified in recipient tissues by their bisbenzimide-fluorescent nuclei and by fluorescein staining of the membrane antigen, H-2Kk. Donor lymphoid cells were observed in histological sections of recipient cervicovaginal mucosa and also in the iliac lymph nodes of 34 of 36 recipient mice 24 h after inoculation into the vagina. The number of donor cells in the iliac lymph nodes was 8.6 +/- 1.4 (mean +/- SEM) cells per mouse with a range of 0-35 cells per mouse. Approximately 28% of the donor lymphoid cells in recipient lymph nodes expressed CD4, which in humans is the receptor for HIV. We did not detect F4/80, a marker of mature mouse macrophages in the donor cell population, on any of the migrating cells in recipient lymph nodes. However, this negative result is equivocal, because the marker might be down-regulated after transfer or the migrating macrophages might be difficult to dissociate from the recipient lymph node tissue. These observations in mice support the suggestion that HIV-containing lymphoid cells in the semen of infected men may invade the cervicovaginal mucosa after sexual intercourse and deliver the virus to a woman's internal environment. However, both the donor cells and the recipient reproductive tract of the mice in the present study differed in significant respects from their counterparts in humans that might be involved in heterosexual HIV transmission. Further studies are needed to determine whether this possible mode of virus transmission is mainly responsible for heterosexual transmission of HIV in humans.

Lymphocyte shedding from genital tract of human immunodeficiency virus-infected women: immunophenotypic and clinical correlates

OBJECTIVE

Our purpose was to describe the lymphocyte subpopulations in genital tract samples from human immunodeficiency virus-infected women and the clinical correlates associated with lymphocyte shedding.

STUDY DESIGN

Genital tract samples of women infected with human immunodeficiency virus-1 were processed for immunophenotyping analysis with a FACScan flow cytometer. Immunologic and virologic characteristics of women with and without lymphocyte shedding were compared with t test, Wilcoxon rank test, or Fisher's exact test.

RESULTS

The rate of genital lymphocyte shedding among human immunodeficiency virus-1-infected women was 39%. Genital shedding was not related to age, race, use of antiretroviral therapy, or positive human immunodeficiency virus-1 culture. A negative rank correlation (r = -0.71, p = 0.047) between CD3+ CD4+ counts in peripheral blood and genital tract was observed. The majority of the lymphocyte cells were CD3+ CD8+, and > 80% of the CD3+ CD4+ cells were memory cells.

CONCLUSION

The immune profile of the genital tract lymphocytes is suggestive of a local mucosal immune response.

The relationship of the postcoital test and semen characteristics to pregnancy rates in 200 presumed fertile couples

OBJECTIVE

To evaluate the postcoital test (PCT) and semen analysis (SA) in the prediction of pregnancy in 200 potentially fertile couples.

METHODS

200 couples without risk for infertility were prospectively followed for 1 year. Couples were attempting pregnancy for 12 menstrual cycles. In the first three cycles, the women underwent monthly PCTs and collected daily urines while the men provided bimonthly semen analyses. For the next nine cycles, the couples were monitored for pregnancy. The PCT included hours post-coitus, amount of mucus, spinnbarkeit, number of motile sperm, and percent of motile sperm. Since multiple PCTs and SAs were available for each couple, values were averaged to provide one mean value per couple. The Wilcoxon ranked sum test was used to detect differences in PCT and SA.

RESULTS

Pregnancy occurred in 163/200 couples (82%) in 12 cycles. Mean sperm count per high-power field (p = 0.01) and mean number of highly motile sperm (p = 0.03) were higher among women in whom pregnancy occurred. Amount of mucus and spinnbarkeit were similar between women who became pregnant and those who did not. Semen concentration, motile sperm count, and percent motile sperm were significantly higher among men whose partner conceived (P < .02). Only 93 couples (47%) had PCTs that were correctly timed.

CONCLUSIONS

Measures predictive of pregnancy included vigorously moving sperm per high-power field, sperm concentration, motile sperm count, and percent motility. Mucus characteristics were not predictive of pregnancy. Additionally, a high number of sperm seen in the PCT correlated with a high number of motile sperm in the SA. These results support the use of the PCT for initial evaluation of the infertile couple.

Sperm counts in enzymatically liquefied cervical mucus: quantitative validation using donor cervical mucus

The post-coital test evaluates the penetration of spermatozoa into cervical mucus; it relies on subjective measurements and therefore lacks precision. Enzymatic liquefaction of cervical mucus allows sperm concentration to be measured in post-coital test samples, but the reliability of such measurements is not known. Donor cervical mucus was used as a model to test the accuracy and sensitivity of sperm quantification in liquefied cervical mucus. Donor cervical mucus was dissolved by enzymatic treatments in the presence of known numbers of spermatozoa and the recovery of sperm cells was assessed after liquefaction of the samples. Enzymatic treatment of cervical mucus with a combination of bromelin and glycosidases resulted in reliable and fast liquefaction of the samples. The accuracy of sperm concentration measurements was 89 +/- 10% (mean +/- SD, n = 50), and the sensitivity limits were 1 x 10(6) and 0.2 x 10(6) spermatozoa/ml for quantitative concentration measurement and qualitative sperm detection respectively. This study demonstrates that liquefaction of cervical mucus by combined protease and glycosidases allows accurate and sensitive determination of sperm concentration in the sample. Therefore we believe that valuable data can be obtained for sperm concentration and total sperm counts in post-coital tests, that should help to improve the reliability of the post-coital test.

Quantitative post-coital test: sperm counts in cervical mucus after enzymatic liquefaction

The post-coital test involves direct microscopic examination of sperm number and motility in cervical mucus. The results depend on the quality of the mucus and the distribution of spermatozoa within the sample. To progress from such qualitative data to quantitative measurements of the spermatozoa present in post-coital mucus, we have developed methods to measure sperm concentrations in enzymatically liquefied post-coital cervical mucus. The mucus score and sperm motility were measured prior to mucus liquefaction, and, together with sperm concentration, they allowed the calculation of the total number of motile spermatozoa present. A combination of bromelin and glycosidases proved to be more efficient in achieving reliable mucus liquefaction than treatment with bromelin alone, and was used to liquefy a series of 36 post-coital test samples. Total sperm numbers ranged between 19 x 10(3) and 16.8 x 10(6). Of the samples, 75% contained < 3 x 10(6) spermatozoa, and 39% contained < 1 x 10(6) spermatozoa. Sperm motility was very high in these samples, except for a distinct subset of samples (19%) in which the total sperm motility was markedly decreased ( < 20%). The measurement of sperm concentration in liquefied cervical mucus will help to determine normal values for the post-coital test, and to estimate the number of motile spermatozoa reaching the upper female genital tract.

Immunological aspects of subfertility

No significant relationship between semen quality [determined by standard sperm analysis and sperm-cervical mucus (CM) interaction testing in vivo and in vitro] and the presence of antisperm antibodies (ASA) [determined using three different methods] in serum samples of males and/or females of subfertile partnerships was found. These circulating ASA were not associated with reduced fertility in prospective studies. On the other hand, ASA in semen, particularly those of the IgA class, significantly impaired the ability of spermatozoa to penetrate CM and the fertility prognosis of the couple. ASA in CM must also be considered as a severe infertility factor but are a very rare cause of poor mucus quality.

Lea's Shield: a phase I postcoital study of a new contraceptive barrier device

Lea's Shield is a new vaginal barrier contraceptive that may offer advantages over existing methods. It is made of silicone which is resistant to petroleum-based lubricants, does not absorb odors, and does not cause allergic reactions in users with latex sensitivity. It has an anterior loop for ease of insertion and removal and a one-way flutter valve. Its novel design has sufficient volume to fill the posterior fornix, which helps keep it in place and prevent sperm from entering the cervical os. This study evaluated with a standard postcoital test (PCT) the ability of the Lea's Shield used with spermicide or non-spermicidal lubricant to prevent sperm from entering midcycle cervical mucus. Ten sterilized women underwent four PCT cycles: one cycle in which no contraceptive barrier was used (a baseline cycle) and 3 cycles in which one of the following was used: Lea's Shield with spermicide, or with non-spermicidal lubricant, or the contraceptive diaphragm used with spermicide. All volunteers demonstrated more than 5 progressively motile sperm per high power field in the cervical mucus after intercourse in the baseline cycle. No motile sperm were found in the cervical mucus in any cycle in which Lea's Shield or the diaphragm was used with spermicide. No motile sperm were found in cervical mucus in 9 of 10 cycles in which Lea's Shield was used without spermicide. Only two progressively motile sperm were present in the cervical mucus of one volunteer who used the shield with non-spermicidal lubricant.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of electro-conization involving the vaginal part of the uterine cervix on cervical mucus parameters]

Parameters of cervical mucus and its penetration by spermatozoa were evaluated in 36 women prior to and after conisation of the vaginal part of uterine cervix. After the procedure: complete absence of fecund mucus was revealed in 9 women (25% of cases); in 23 the mucus parameters and the penetration test results were not significantly changed (63.8% of cases) and 4 women became pregnant (11% of cases). The results of studies indicate that in the majority of cases this procedure fails to influence the parameters of mucus, although in a part of cases it may lead to its complete disappearance.

[Pap cell test laboratory report]

The Papanicolaou smear is done to detect preinvasive lesions (eg. dysplasia, carcinoma-in-situ) as well as invasive lesions. To ensure that a smear is suitable for laboratory examination, the nurse must know the reasons why a smear cannot be analysed. When a smear is sent to the laboratory it will analysed to see if any of the following are present: atypical cells, neoplastic cells, endometrial cells or infections. When the nurse gets the result back she must be able to interpret the results and be able to guide the patient to the correct form of treatment.

Cervical mucus secretory IgA in adenomatous polyp, intraepithelial neoplasia and squamous cell carcinoma of the cervix

Cervical mucus secretory IgA concentration ([sIgAc]) was significantly higher in 36 CIN (cervical intraepithelial neoplasia) patients than in 360, age, reproductive status and smoking habit-matched controls. Also, CIN ranked first compared with adenomatous polyp (29 cases), primary or secondary invasive esocervical carcinoma (IEC) (21), ectropion/erosion (49) and specific (27) or aspecific (80) cervicitis. CIN carried the highest proportion of cases with [sIgAc] detectable (86%) or beyond the cut-off value (33%) (IEC: 14% and 0%, respectively). [sIgAc] was inversely related to CIN grade and higher, though nonsignificantly, in patients with HPV-positive CIN biopsy specimens. Histologic and immunologic factors can account for the differences in [sIgAc] observed within the spectrum of neoplastic lesions of the cervix.

[The significance of endometrial cells in the cervical smear]

Presence of atypical endometrial cells in a cervical smear is quite unusual; but if they are found the woman needs extra attention because of the risk of adenocarcinoma of the uterus. Postmenopausal women sometimes also have endometrial cells without atypia in the cervical smear, as a sign of endometrial pathology. We conducted a retrospective follow-up study of these women. From 1978 to 1989, 52 smears from a total of about 50,000 postmenopausal women were classified as Pap IIIA, due to the presence of normal endometrial cells. Histological follow-up was performed in 25 cases and 3 times an adenocarcinoma of the endometrium was diagnosed (6%). The smears from 142 women (pre- and postmenopausal) contained atypical endometrial cells and therefore were classified as Pap IIIA or higher. Histological follow-up was performed in 104 cases. In 48% (n = 68) an adenocarcinoma was diagnosed. In 75% of these cases (n = 51) the atypical cells were graded as severe or worse (> or = Pap IIIB). Cervical smears are not taken to detect pathology of the endometrium, but whenever atypical cells are found in the smear there is a strong indication for further (gynaecological) examination.

The leukocytic reaction of the human uterine cervix

PROBLEM

Sperm interaction with the immune system of the human cervix is poorly understood.

METHOD

The leukocytic response of the human cervix to sperm was examined in a closely monitored patient population (N = 10), using monoclonal antibody cell identification techniques. Baseline data were collected from both cervical mucus and smears sampled before treatment by donor insemination. Donor insemination was timed to coincide with ovulation by monitoring plasma LH concentrations twice daily. Following insemination the numbers of leukocytes were recorded in cervical mucus and smear samples taken over a 24-h period relative to the time of treatment. Controls treated with "pure sperm," seminal plasma, cryopreservative, and cervical smearing alone were also included in the study.

RESULTS

Only those women treated with sperm cells exhibited substantial elevations in leukocyte numbers following inseminations. Additionally, serial cervical smearing induced an inflammatory response of the cervix. In all the women, the neutrophil was the predominant leukocyte of the cervix both during the baseline and treatment periods (median values ranged from 77 to 86%). Macrophages, T-helper lymphocytes, and T-suppressor lymphocytes were also detected, but only in low numbers (2-10.6%). Two patients and one control ("pure sperm") became pregnant during their study cycle.

CONCLUSIONS

We conclude that the leukocytic reaction is a physiological response of the cervix to sperm, the function of which remains to be established.

Mucopurulent cervicitis as a predictor of chlamydial infection and adverse pregnancy outcome. The Investigators of the Johns Hopkins Study of Cervicitis and Adverse Pregnancy Outcome

The role of mucopurulent cervicitis in identifying pregnant women with Chlamydia trachomatis infection and poor pregnancy outcome was examined at the Johns Hopkins Hospital Obstetric Clinic in Baltimore, Maryland. The women studied were at high risk for chlamydial infection (14%), low birthweight (12%), and preterm delivery (13%). Yellow endocervical discharge on a cotton swab had a sensitivity of 23.9%, specificity of 89.4%, and positive predictive value of 28.6% for predicting chlamydial infection. The presence of greater than or equal to 30 polymorphonuclear cells per 1000 x field had a sensitivity of 25.0%, specificity of 87.6% and positive predictive value of 24.3%. Women with cervicitis defined by greater than or equal to 30 polymorphonuclear cells per 1000 x field were twice as likely to deliver a low-birthweight infant. Adjustment for potential confounding variables did not explain this association. The poor sensitivity, specificity, and positive predictive value of mucopurulent cervicitis suggests that this parameter is not a useful screening tool for chlamydial infection in pregnant women. However, mucopurulent cervicitis may be an indicator of increased risk for poor pregnancy outcome.

Positive immunoselection--a method of isolating leukocytes from leukocytic reacted human cervical mucus samples

In this brief communication we report a simple and accurate method of isolating and quantifying specific leukocytes from midcycle human cervical mucus, using monoclonal antibody-coated magnetic beads. Cervical mucus samples (pre- and postinsemination) were broken down enzymatically and incubated with a series of these beads. This method of positive immunoselection consistently retrieved representative levels of leukocytes (means = 73.8% +/- 1.59%; mean leukocyte retrieval rate +/- S.E.) from the cervical mucus samples. Significantly more leukocytes (P less than 0.0001) were isolated from the postinsemination samples, the predominant leukocyte of which was the neutrophil, which comprised 83% of the leukocyte population. These results reaffirm that a leukocytic influx is initiated across the human uterine cervix following the introduction of semen samples, the function of which is possibly phagocytic clearance of the nonfertilizing population of sperm.

Expression of blood group A and B antigens in nuclear heterochromatin in mucous cells of human cervical glands

Using a post-embedding immunogold labeling procedure, we found that monoclonal antibody against A (MAb-A) or B antigen (MAb-B) reacted with nuclear heterochromatin regions, as well as secretory granules, in mucous cells of human cervical glands. Systematic and critical observation of specimens from 24 individuals of different blood groups revealed that the labeling pattern with MAb with strictly dependent on the blood group (A,B, or O) of the donors, i.e., MAb-A reacted with the heterochromatin from blood group A and AB but not with B and O individuals. Labeling with MAb-B was also specific for the heterochromatin from blood group B donors. On the other hand, MAb against H antigen did not react with the heterochromatin from any individuals examined, despite the fact that H antigens were detected by the MAb in secretory granules. Such specific reactions provide evidence that certain types of blood group-related antigens exist in the nuclear heterochromatin in mucous cells of human cervical glands. In contrast to the secretory granules in which ABH antigens were recognized by blood group-specific lectin, heterochromatin regions had little or no affinity for these lectins. Furthermore, the secretory status of individuals affected the staining intensity with MAb in secretory granules but not in the heterochromatin. These results suggest that the blood group substances found in the heterochromatin may have different molecular properties from those in the secretory granules, although both have the same determinant structures of ABH antigens.