Cervical mucus is produced by the cervix and its composition changes throughout a woman's menstrual cycle in response to hormones. Around ovulation, cervical mucus becomes copious, clear and elastic due to high estrogen levels, which helps sperm survive and facilitates their passage through the cervix. After ovulation, progesterone causes the mucus to become thicker and less elastic. Examining the characteristics of a woman's cervical mucus can provide information about her hormonal status and fertility and may help with infertility investigations.

1. CERVICAL MUCUS
EXAMINATION

2. CERVICAL MUCUS EXAMINATION
INTRODUCTION
cervical mucus is produced by cervix when
the hormone estrogen rises. Estrogen level is
begins low, then climes to its peak at ovulation
before dropping again. The most important
aspect is that vaginal & cervical dryness is often
left un-noticed and that can lead to infertility.

3. CERVICAL MUCUS EXAMINATION
Cervical mucus is secreted by the columnar lining of
the cervix
Endocervical glands :20-60 ml/day
600 ml around the time of ovulation

4. CERVICAL MUCUS EXAMINATION
ROLE OF CERVICAL MUCUS
Receptivity:
To sperm penetration at, or near, ovulation and
interference with penetration at other times.
Sperm protection:
Hostile environment of the vagina.
Energy supplementation
Filtration:
Sperm selection (motility and morphology).
Reservoir:
Short term sperm reservoir.
capacitation

5. CERVICAL MUCUS EXAMINATION
INDICATIONS
 Bacteriological Study
 Hormonal Status
 Infertility Investigation

6. CERVICAL MUCUS EXAMINATION
Bacteriological Study
Cusco’s bivalve speculum is introduced
without lubricant.
with the help of a sterile cotton swab, the
cervical canal is swabbed
The material is either sent for a culture or
spread over a microscope slide for gram
staining

7. CERVICAL MUCUS EXAMINATION
Hormonal Status
The physical, chemical and cellular
components of the cervical secretions are
dependent on hormones-estrogens and
progesterone.
Oestrogen increases the water and electrolyte
content with decreases in protein.
As, such the mucus become copious, clear and
thin.

8. CERVICAL MUCUS EXAMINATION
Progesterone on the other hand ,decreases
the water and electrolytes but increases the
protein.
As, a result the mucous becomes scanty, thick
and tenacious.
The influence of the hormones on the cervical
mucous is utilized in detection of ovulation in
clinical practice. The around the time of
ovulation is about 6.8 – 7.4.

9. CERVICAL MUCUS EXAMINATION
Spinnbarkelt (stretch ability or elasticity)
During the mid cycle, the cervical secretion is
collected with a pippete and placed over a glass slide.
Another glass slide is placed over it.Because of
increased elasticity due to high estrogen level during
the period, the mucus placed between the slides can
withdrawn stretching up to a distance of over 10 cm
After ovulation, when corpus luteum forms,
progesterone is secreted.
Under its action, the cervical mucus loses its property
of elasticity and the mucus fractures if the same is
attempted.
This loss of elasticity after its presence in the mid
cycle is the indirect evidence of ovulation.

10. CERVICAL MUCUS EXAMINATION
FREN TEST
During the midcycle,the cervical mucus is obtained by a
platinum loop or pipette and spread on a clean glass
slide and dried.
When seen under low powder microscope it shows
characteristic pattern of fern formation
It is due to high sodium chloride and low protein content
in the mucus due to high estrogen in the midmenstrual
phase prior to ovulation.
After ovulation with increasing progestron,the ferning
disappears completely after 21st day.
Thus, the presence of ferning even after 21st day
suggests anovulation and its disappearance is
presumptive evidence of ovulation.

11. CERVICAL MUCUS EXAMINATION
INFERTILITY INVESTIGATIONS
Post coital test
The patient should report to the clinic preferably within
8-12 hours of following intercourse.
The cervix is exposed with a cuscus speculum, using a
polyethylene catheter attached to syringe.
The endocervical mucus is collected and placed over a
warm glass slide and its examined microscopically.
Presence of at least 10 progressively motile sperms
signifies the test to be normal
Absence of ant sperm signifies either aspermia or
imperfect coital techniques and the test should be
repeated and examined within 2-4 hours of inter course
Presence of immotile sperm with a normal sperm count
in a good quality of cervical mucus signifies presence of
immunological factors