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Sperm antibodies in infertile women: a comparison of three methods for handling the cervical mucus for extraction of immunoglobulins.

Three procedures commonly employed in the extraction of soluble proteins from cervical mucus, for the application of the technique for the detection of sperm antibodies also in this biological fluid, were compared in order to establish which provided the highest yield. Studies were therefore carried out on 125 women with primary and secondary sterility characterized by good rheologic qualities of their mid-cycle cervical mucus and in presence of repeatedly poor PCTs, not justified by the seminal characteristics of their partners. The laboratory results and the statistical analysis have shown that as far as concerns IgG, liquefaction with bromelin and solubilization with Baker's buffer provide a better yield than ultracentrifugation; while bromelin alone has the best yield with IgA.

Agglutination Tests↗

Natural family planning. I. The peak symptom and estimated time of ovulation.

The observation of the "Peak" mucus symptom in women using the ovulation method of natural family planning has been correlated with the estimated time of ovulation, as evaluated by indirect hormonal parameters. In 65 cycles of the 73 studied in 24 patients, there was hormonal confirmation of ovulation; in eight cycles, anovulation or luteal dysfunction was suspected. In the 65 normal cycles, 64 exhibited a Peak symptom. In those cycles, ovulation was estimated to occur from 3 days before to 3 days after the Peak symptom with a mean of 0.31 days before the Peak symptom. In 95.4% of these cycles, ovulation was estimated to occur from 2 days before to 2 days after the Peak symptom. The variation between cycles of the same patient ranged from 0 to 4 days with a mean of 1.8 days. The beginning of the mucus symptom preceded the estimated time of ovulation by an average of 5.9 days.

Adult↗

[Penetration of cervical mucus by native and cryopreserved sperm--the Kremer test].

OBJECTIVE: The penetration of native and cryopreserved human spermatozoa into cervical mucus--the Kremer's test. DESIGN: Retrospective study. SETTING: Department of Obstetrics and Gynaecology, Medical Faculty, Charles University and Faculty Hospital, Plzen. METHODS: Human cervical mucus was collected from 73 women visiting the Division of immunology of reproduction, Department of Obstetrics and Gynaecology in Plzen. Native spermatozoa was obtained from the patients of the Division of Immunology of Reproduction as well. Cryopreserved only in its seminal plasma was obtained from the spermabank of our department. The distance of penetration in centimetres from the start was examined in inverse microscopy after 30, 60, 90 and 90 minutes. Also the character and duration of the sperm motility was analyzed. RESULTS: The penetration of native spermatozoa was higher than the penetration of cryopreserved spermatozoa in each case. The native spermatozoa had a higher penetrability, motility and life-ability. Spermatozoa preserved only in its seminal plasma had the parameters demonstrably lower. Nevertheless these spermatozoa can be successfully used for homologue or heterologue insemination or for IVF because these spermatozoa do not loose its enzymatic and remaining energetic equipment by penetration the cervical canal. CONCLUSION: The Kremer's test belongs to the reliable methods of penetration ability of native and cryopreserved sperms.

Adult↗

Natural methods of family planning.

Reliable indicators to detect the fertile and infertile phases in the menstrual cycle are now available, largely due to the intensive scientific research into fertility over the past decade. This means that couples who follow the rules of the different NFP methodologies have a highly effective means of birth control, without the introduction of hormones, chemicals or devices into the body. New scientific techniques can be expected within the next couple of years which will simplify the detection of the fertile phase and hopefully help to elucidate the grey area of the early fertile days, where most of the unplanned pregnancies occur. Fertility awareness by both partners is an important positive contribution to the whole sexual relationship and emphasizes that NFP is an educational delivery system rather than a technological one. The modification of sexual behaviour and the motivation of both partners for the successful use of NFP may initially present a problem to some couples. On the other hand, many partners find the discipline enhances their sexual relationship and dialogue. Whatever the motivation, today more and more couples are happier to be in autonomous control of their bodies and their fertility.

Body Temperature↗

Natural family planning.

It is now well accepted that a woman can conceive from an act of intercourse for a maximum of only about 7 days of her menstrual cycle. The reliability of natural family planning depends on identifying this window of fertility without ambiguity. Several symptomatic markers, cervical mucus and basal body temperature, have been used extensively and with considerable success in most women but failures occur. Ovarian and pituitary hormone production show characteristic patterns during the cycle. Urinary estrogen and pregnanediol measurements yield reliable information concerning the beginning, peak, and end of the fertile period, provided that the assays are accurate and performed on timed specimens of urine. We have developed such enzyme immunoassays for urinary estrogen and pregnanediol glucuronides that can be performed at home. In the early versions of the assays, enzyme reaction rates were measured by eye, but more recently, a simple photoelectronic rate meter has been used. The final problem to be solved is not technologic but whether women are sufficiently motivated to expend the same time and effort each day for 10 days a month, with less cost, on fertility awareness as they spend on making a cup of tea.

Adult↗

Sperm antigens and autoantibodies: effects on fertility.

There are several antigens of the human sperm cell that can stimulate production of autoantibodies in certain individuals. This occurs in a number of spontaneous cases and leads to a condition of immunological infertility. It also occurs in a majority of men who have had a vasectomy. There are currently many new developments for the detection of the antibody, the study of its significance, and in the treatment of this autoimmune disease. As for the diagnostic testing of the serum, there are the classical methods of agglutination, namely, GAT, TSAT, TAT, and CTAT, and of immobilization. There are also the newer methods of the passive hemagglutination assay, the radio-label-antiglobulin test, the ELISA, the hemadsorption procedure, and the ATP-luminescence cytotoxicity method, plus indirect MAR (mixed antiglobulin reaction) and IBT (immunobead test) procedures. For testing of the genital secretions, sperm cells can be evaluated directly by the MAR and IBT methods, and cervical mucus, after being dissolved, can be tested by the MIS (microscale method) or an indirect IBT procedure. Interpretations of the significance of sperm antibody have been passed on epidemiologic values and also on direct fertilization-inhibition studies. Treatment of the antibody problem has been based on several approaches, but the most promising approach has been the use of intermittent high-dose steroid medication. A number of studies have shown good results by this procedure of immunosuppression.

Adrenal Cortex Hormones↗

Critical evaluation of methods for electron microscopy of cervical mucus.

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.

Cervix Mucus↗

Natural family planning after pregnancy. A problem for women with previously irregular menstrual cycles.

A prospective six-year study (1975-1980) of 273 patients, monitored in the use of natural family planning (NFP), has shown that those with previously irregular menstrual cycles are disadvantaged in the subsequent use of the ovulation method after pregnancy in that they have fewer recognizable safe days and/or are more likely to have unplanned pregnancies than women who had regular cycles prior to pregnancy. Eight patients, seven nursing and one non-nursing mother, conceived during postpartum amenorrhoea. The reliability of memory in the recall of previous menstrual histories is discussed in relation to the results of an international study of menstrual cycles by the World Health Organization (WHO 1983). The relevance of prediction of menstrual events in natural family planning is also considered.

Amenorrhea↗

Efficacy of three variations of periodic abstinence for family planning in Indonesia.

A prospective study to determine the efficacy of three alternative guidelines for the practice of periodic abstinence (PA) for family planning was conducted in Indonesia. The three methods studied were the Billings ovulation method, the Dorairaj modified mucus method, and a local version of the mucus method. For each method, the study encompassed a three-month learning phase and an additional 12-month effectiveness phase. Data from a total of 850 acceptors showed that, despite some variations in the sociodemographic characteristics of the acceptors, the Billings ovulation method had the lowest (10.4 per 100 women) and the local mucus method had the highest (26.5 per 100 women) overall life-table discontinuation rates in the effectiveness phase. One-year life-table unplanned pregnancy rates ranged from 2.5 per 100 women for the Billings method to a high of 11.5 per 100 women for the local method acceptors. Unplanned pregnancy was the main reason for termination.

Adult↗

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.

Antibodies, Monoclonal↗