The elasticity of cervical-vaginal secretions is abnormal in polycystic ovary  syndrome: Case report of five PCOS women

Nabila Shamim; Stephen J Usala; William C Biggs; Gregory B McKenna

doi:10.4103/2230-8210.103030

Reproductive Endocrinology · Ovulation Physiology

The elasticity of cervical-vaginal secretions is abnormal in polycystic ovary syndrome: Case report of five PCOS women

Shamim N, Usala SJ, Biggs WC, McKenna GB

Published November 2012 Indian Journal of Endocrinology and Metabolism, 16(6), 1019-1021

DOI 10.4103/2230-8210.103030 PMID 23226656 PMC PMC3510930

RRM Academy Synopsis

Cervical fluid elasticity lacks a cycle pattern in 5 women with PCOS

A case series of 5 women with polycystic ovary syndrome (PCOS) found that their cervical fluid was typically less elastic than in ovulatory women and lacked a cycle pattern. PCOS is now named polyendocrine metabolic ovarian syndrome (PMOS). Metformin did not restore the pattern, even when it induced ovulation in two of them.

Key Findings

Five ovulatory women contributed 13 cycles. Their fluid elasticity fell to a minimum one to two days before ovulation and rose after it.
No periodic change in cervical-vaginal fluid elasticity appeared in any interval or cycle of the 5 women with PCOS, with or without metformin.
Elasticity in 4 of the 5 women with PCOS was significantly lower than normal day-specific levels (P < 0.05). The fifth, a woman with high testosterone, did not differ significantly.
Metformin induced ovulation in 2 women with PCOS, and the normal elasticity pattern did not return in either.

Interpretation

This case series followed five women with PCOS, three of them also with type 2 diabetes. Five ovulatory women served as controls, and all participants were ages 19 to 41. Each woman collected cervical-vaginal fluid with a vaginal aspirator, and a die swell ratio measured its elasticity. The authors describe the cause of the low elasticity as unknown and hypothesize reduced secretion of a mucus protein, MUC5B. They state that larger studies are needed before this measurement is recommended in routine clinical practice.

RRM Context

Daily observation of cervical fluid is a core sign in fertility awareness-based methods. The authors describe cervical mucus as critical for sperm transport and conception. In five women with PCOS, a laboratory measure of that fluid lacked the usual fertile-window pattern, including in two whose ovulation had been induced. Restorative care asks whether each sign of the ovulatory cycle returns. Cervical fluid is one of them.

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

Abstract

Polycystic Ovary Syndrome (PCOS) is a leading cause of infertility. We studied the rheological properties of cervical-vaginal secretions in five PCOS patients during variable treatment intervals with metformin. Five ovulatory normal women for a total of thirteen cycles served as control patients. All subjects collected daily cervical-vaginal fluid(CVF) samples with an aspirator, and CVF samples were characterized by a flow metric, die swell ratio (B), which measured CVF elasticity. Ovulatory cycles were indexed to the day of positive urine or serum LH (luteinizing hormone). CVF B levels from ovulatory normal women had a characteristic concave parabolic pattern of a minimum near the day of ovulation with higher values outside the periovulatory phase. In contrast, the five PCOS patients with or without metformin treatment had no periodicity of CVF B, and their CVF B levels were typically less compared to those in the early preovulatory and luteal phases of normal patients.

Topics

Reproductive Endocrinology › Ovulation Physiology › Anovulation · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances · Diagnostics › Cycle Biomarkers › Cervical Mucus Monitoring

Nabila Shamim, Stephen J Usala, William C Biggs, Gregory B McKenna

N Shamim, Steve Usala, S Usala, Bill Biggs, Will Biggs, Billy Biggs, W Biggs, Greg McKenna, G McKenna

PMID 23226656 23226656 DOI 10.4103/2230-8210.103030 10.4103/2230-8210.103030 Shamim et al. 2012, Shamim 2012

The elasticity of cervical-vaginal secretions is abnormal in polycystic ovary syndrome: Case report of five PCOS women

Cervical fluid elasticity lacks a cycle pattern in 5 women with PCOS

Key Findings

Interpretation

RRM Context

Abstract

Topics

Related research

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

Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome

Fertile window and biophysical biomarkers of cervical secretion in subfertile cycles: a look at biotechnology applied to NaProTechnology

Correlation of plasma gonadotrophins and ovarian steroids pattern with symptomatic changes in cervical mucus during the menstrual cycle in normal cycling women