Scanning electron and light microscopy study of the cervical mucus in women with  polycystic ovary syndrome

Pilar Vigil; Manuel E Cortés; Ana Zúñiga; Jessica Riquelme; Francisco Ceric

doi:10.1093/jmicro/dfn032

Reproductive Endocrinology · Ovarian Hormones

Scanning electron and light microscopy study of the cervical mucus in women with polycystic ovary syndrome

Vigil P, Cortés ME, Zúñiga A, Riquelme J, Ceric F

Published January 15, 2009 Journal of Electron Microscopy, 58(1), 21-27

DOI 10.1093/jmicro/dfn032 PMID 19141465

RRM Academy Synopsis

Cervical mucus looked denser in PCOS women who did not ovulate

Mucus pores averaged 1.8 μm in PCOS women without ovulation and 15 μm in controls, a 10-woman study found. PCOS women who ovulated had mucus that looked similar to the controls', with pores averaging 8.4 μm. PCOS is also called PMOS (Polyendocrine Metabolic Ovarian Syndrome).

Key Findings

Ten women took part: 4 controls with normal ovulatory cycles, and 6 with PCOS, of whom 2 had ovulatory cycles and 4 had cycles without ovulation.
Average pore diameter under the scanning electron microscope was 15 μm in controls, 8.4 μm in PCOS women with ovulatory cycles and 1.8 μm in PCOS women without ovulation.
Mucus from PCOS women without ovulation appeared denser and more impenetrable than the mucus of the other two groups.
Control mucus dried into well-defined patterns: fern-like (L, P2), rectilinear (S) and hexagonal (P6). PCOS women with ovulatory cycles showed crystallization resembling type L mucus.
PCOS women without ovulation showed a poorly defined, atypical crystallization, plus areas resembling type G mucus.

Interpretation

The study is a small single-clinic series of 10 women in Chile, with 2 to 4 women per group and no statistical tests reported. The findings describe these samples. The authors suggest that hormone differences in women without ovulation could explain the denser mesh, and that small pores could hinder sperm movement. The study measured neither sperm movement nor fertility, and its design cannot show that hormones caused the differences. The authors add that women with PCOS can be fertile and have ovulatory cycles, and their mucus characteristics were normal.

RRM Context

Fertility awareness-based methods teach women to watch cervical mucus as a sign of the fertile window. In this small sample of women with PCOS (PMOS), the microscopic look of mucus differed by ovulatory status. Ovulation is the root-cause question in a restorative evaluation.

Our editorial summary of this paper, not the article's abstract.

Abstract

Two types of cervical mucus are recognized, oestrogenic and gestagenic. These are constituted by different subtypes, and their characteristics change depending on variations in the hormonal levels and on the existence of several pathologies. Our aim was to identify the ultrastructure and crystallization characteristics of the cervical mucus in women suffering from polycystic ovary syndrome, and to compare these characteristics with those of normal control women. Cervical mucus samples were taken from 10 women, 4 control group women (with normal ovulatory menstrual cycles) and 6 suffering from polycystic ovary syndrome (2 with ovulatory and 4 with anovulatory cycles). This mucus was characterized according to its ultrastructure and crystallization. The type of mucus obtained was related to the levels of oestradiol and progesterone present when the samples were taken. As regards mucus ultrastructure, differences were found between the control women and those with polycystic ovary syndrome and anovulatory menstrual cycles. Such variations were evident in the type of mesh and the average diameter of the mucus pores. Mucus crystallization in control women showed the usual oestrogenic disposition: fern-like (L, P2), rectilinear (S) or a hexagonal structure (P6). On the other hand, in women with polycystic ovary syndrome, indefinite mucus crystallizations were found, as well as crystallization patches resembling oestrogenic and gestagenic-like mucus. This study shows that the ultrastructure and crystallization characteristics of the cervical mucus in polycystic ovary syndrome women are different from those of control women. The latter would be dependent on their levels of oestradiol and progesterone.

Topics

Reproductive Endocrinology › Ovarian Hormones › Estrogen · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances · Diagnostics › Cycle Biomarkers › Cervical Mucus Monitoring

Pilar Vigil, Manuel E Cortés, Ana Zúñiga, Jessica Riquelme, Francisco Ceric

P Vigil, M Cortés, A Zúñiga, Jess Riquelme, J Riquelme, F Ceric

PMID 19141465 19141465 DOI 10.1093/jmicro/dfn032 10.1093/jmicro/dfn032 Vigil et al. 2009, Vigil 2009

Keywords

Progesterone, Estradiol