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If the mucus is good but the postcoital test is repeatedly bad, an 'in-vitro' mucus penetration test, or sperm invasion test, can be performed. This is performed simply by putting a drop of freshly removed mucus next to a drop of freshly ejaculated semen on a microscope slide. The interface between the two drops is examined after approximately 15 minutes, and it is then possible to see if the sperm are penetrating the mucus and swimming actively in it. If this does not occur, then it is likely that there is some form of immune reaction between the sperm and the mucus, and further tests should be conducted to examine this.
Crossover testing can be performed using the mucus and semen under examination in various combinations with donor mucus and semen. This will show if the problem is with the sperm or the mucus.
Another simple test for antisperm antibodies in the mucus is called the sperm cervical mucus contact test (SCMC for short) where the sperm and mucus are mixed together. If, under the microscope, the sperm are seen to be shaking in a characteristic way, this means that there are antibodies present.
Cervical problems can be corrected depending upon what the cause is. For example, if the reason for the poor mucus is lack of ovulation, then ovulation can be induced; if the reason is cervical infection, then this can be treated by cauterizing or freezing the abnormal cervical tissue, so that this tissue is destroyed, and is then replaced by healthy cervical glands; if the mucus is thick or viscous, then occasionally this can be treated by expectorants (cough medicines) such as guaifenesin, which can help to stimulate the production of thinner, more abundant mucus; if the mucus is scanty, then "donor" mucus (from another woman) can be used or mucus production enhanced by supplemental low-dose estrogens.
For resistant cervical problems, the easiest solution may be to bypass the cervix entirely, by injecting the sperm direct into the uterus a procedure called intrauterine insemination.
Sometimes the problem is one of cervical hostility to the sperm - antisperm antibodies in the mucus kill or immobilize the sperm. For this condition the outlook is now more hopeful.
Some doctors recommend that the woman avoid contact with sperm for a period of time. This may cause the antibodies to disappear because their production is no longer being stimulated by repeated exposure to the antigen. The couple can have sex, but the husband must wear a condom so that the sperm don't come into contact with the cervix. This course may be recommended for six months, until the antibodies have disappeared. This treatment is rarely suggested now-a days for obvious reasons!
Some doctors have tried insemination with the husband's semen directly into the uterus intrauterine insemination. This means bypassing the cervix and therefore the site of the antibodies. This treatment has had limited success in some clinics but there is doubt about its value. This is because if antibodies are being produced, they may be in the fallopian tube and the uterine cavity as well.
Steroids may be given to prevent production of antibodies. To be effective they have to be given in high doses and this may cause serious side effects. However, these treatments are rather experimental and not definitely effective.
IVF can be tried. The presence of antisperm antibodies in the cervix will not interfere with in vitro fertilization; and this may be a treatment option for patients who have not responded to simpler treatments.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
