Cervical factor

By cervical factor we understand the causes of infertility that are caused by abnormalities in the cervix. We include here the incorrect consistency and quality of the cervical mucus as well as the incorrect anatomical structure of the cervix, which make its environment unfavorable for the viability, mobility and penetration of sperm, and thus the fertilization process is hindered. It is estimated that the cervical factor causes infertility in about 20-30 thousand couples, so it is relatively common. In identifying the cervical factor, the so-called post-intercourse test, or Sims-Huhner test, is used as the cause of infertility. Pharmacological treatment usually does not bring the desired effects and very often the only method of having children in this case are assisted reproductive techniques, mainly intrauterine insemination.

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1. Abnormalities in the cervical factor of infertility

Most often, the cervical infertility factor is caused by an inadequate quality of the cervical mucus. Under normal conditions, the properties of the cervical mucus change depending on the phase of the menstrual cycle. Increasing the concentration of estrogens in the first phase of the cycle (follicular) up to and including ovulation causes the amount of mucus to increase and it becomes watery, transparent and very malleable, creating a favorable environment for the viability, motility and penetration of sperm.In turn, in the second phase (luteal), the concentration of progesterone increases, making the mucus thick, sticky, unfavorable and impermeable to sperm. Sometimes, however, these natural changes in mucus quality become disrupted and throughout the menstrual cycle, mucus has properties that are unfavorable to sperm, making fertilization difficult or even impossible.

It also happens that the cervical factor is due to the anatomical abnormalities of the cervix. It happens very often after electroconization procedures due to erosion. The resulting anatomical changes make it difficult for sperm to penetrate the cervical canal into the uterine cavity. Therefore, in women wishing to have children, electroconization should only be performed when absolutely necessary.

2. Recognition of the cervical factor of infertility

The most widely used method to identify that the cervical factor is the cause of infertility in a given case is the so-called post-intercourse test, or the Sims-Huhner test. It is based on an assessment of the cervical mucus at a certain time after intercourse. This assessment includes examination of the quantity, clarity and ductility of the mucus, as well as the degree of opening of the cervical canal (the so-called pupil symptom) and examination of the presence of sperm in the mucus, their number in the field of vision, movement and its character. All these parameters are scored on a point scale and on this basis it is confirmed or excluded that the cause is
infertility is the cervical factor. An abnormal test result may be affected by inflammation of the vagina, estrogen deficiency or the presence of antibodies agglutinating sperm.

3. Treatment of the cervical infertility factor

In general, drug treatment is attempted. They use anti-inflammatory drugs, estrogens to improve mucus quality, and sometimes glucocorticosteroids to reduce the amount of anti-sperm antibodies produced. Usually, however, these methods are not effective, and then the only chance to have children is assisted reproductive techniques, mainly intrauterine insemination. The prerequisite for the effectiveness of this method is the correct sperm parameters and the correct anatomical condition of the uterus and fallopian tubes.

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