IN ORDER to establish the causes of the failure of the Ogino-Knaus (rhythm)

Transcription

1 Vitality of Spermatozoa in the Endocervical Canal ROBERTO NICHOLSON, M.D. IN ORDER to establish the causes of the failure of the Ogino-Knaus (rhythm) method of birth control (based on the limitation of the so-called genesic period of women), we have investigated the life span of spermatozoa in the endocervical canal, working on the hypothesis that the canal forms a suitable receptacle in which sperm life would be prolonged. The cervix apparently is the part of the genital tract which most favors sperm survival. The duration of motility of spermatozoa in the endocervix has been reported by various authors. Fraenkel found it to be 8 days; Macomber, 7 days; Stein and Cohen 6 days (with stilbestrol); Lane Roberts et al., 5 days; Huehner, 5 days; Tietze, 96 hr. (fertile hr.); Cary, 84 hr.; Figueroa Casas and Gonzalez Garcia, 80 hr.; Williams and Simons, hr.; Cohen and Stein, 58 hr.; Weinstein, 5 hr.; Moench, 48 hr. (fertile); Rock, 48 hr.; Runge, 48 hr.; Joel, 40 hr.; and Bickenbach and Doering, 6 hr. (fertile). Cary found that the temperature of the cervix is F., a temperature not generally considered suitable for sperm; he concluded that the greater vitality of sperm should be explained chemically rather than thermically. Cary observed viable spermatozoa in the cervical canal ( 2-4 per high-power field) 80 hr. after coitus. The long life of sperm in the endocervical canal is understandable if one views the canal as a storage vessel.4 12 Figueroa Casas7 observed that although viability may be normal any day of the cycle, more viable spermatozoa were found between the eleventh and seventeenth day. The American Society for the Study of Sterility1 maintains that sperm may easily penetrate the cervical mucus only during a 12- to 72-hr. period in the cycle. Moench stated that spermatozoa are only fertile for 48 hr.; the presence of sperm in the cervical canal up to 7 days after coitus would indicate that they are too weak to penetrate the cervical mucus or that conditions in the canal are not normal. Stein and Cohen examined 25 sterile patients B~-72 hr. after coitus to evaluate the From the Department of Gynecology, Universidad del Salvador, Buenos Airl"s, Ar~rentina. 758

2 VoL. 16, No. 6, 1965 SPERM VITALITY 759 penetration capacity of sperm and came to the conclusion that sperm survival in the endocervical canal for longer than 24 hr. indicates a period of ovulation. METHOD The subjects in this study were 85 private patients who wished to establish the genesic period in order to control birth through periodic continence. Each had delivered 1 or more children, so they were presumably fertile. Most of the patients were in the preovulatory period when examined. The method of examination of the patients was similar to that used in the sperm viability test; two samples of the endocervical content were taken, usually from the middle third of the tract. The first sample was observed directly, and the second after staining with a 5% solution of eosin in water. The cervical mucus was analyzed and its crystallization designated as negative, 1 +, 2+, or +, according to intensity. Two hundred and twenty-six examinations were done, with only one per cycle. Of the 226 cycles, we were unable to study the duration of 50. In the remainder we found 149 eumenorrheal and 26 oligomenorrhea! cycles. There was 1 pregnancy. RESULTS The time of ovulation was determined by measurement of the basal temperature. Ovulation was considered to correspond with the time of lowest temperature before the thermic increase signifying the beginning of the second phase. In cycles, time of ovulation could not be determined by this method, and in 12, the temperature curve was clearly straight (nonovulatory cycles). Data were insufficient in 41 cases. In the majority ( 17 cycles) ovulation occurred between the twelfth and twenty-first day of the cycle, occurring most often on the sixteenth and seventeenth days. Specimens from the endocervical canal were classified as those exhibiting ( 1) motile sperm, ( 2) only immotile sperm, and ( ) no sperm. The examinations were made between the seventh and twenty-third day of the cycle. An attempt to relate the cycle day the specimen was obtained to the finding of spermatozoa yielded insignificant results. The distribution of the specimens with respect to the cycle day (prior to examination) on which the patient had had intercourse is shown in Table 1. The data given in Table 2 show the relationship between the presence of sperm and the interval between intercourse and examination. Sperm may be found up to 8 days after coitus; sperm were found in the first 5 days in a third to half of the material. The presence of motile sperm up to 6 days

3 760 NICHOLSON FERTILITY & STERILITY TABLE 1. Distribution of Specimens According to Day of Cycle on which Last Coitus Took Place No. of specimens Cycle day Motile sperm lmmotile. perm No. perm 1'otal TOTAL and immotile up to 8 days after coitus demonstrates the prolonged life of sperm in the endocervical canal. Table shows the survival of sperm cells in relation to the time elapsed since the last intercourse and the degree of crystallization of cervical mucus. The presence of sperm, motile or not, is more likely when the cervical mucus is crystallized ( 2+ and +); survival of spermatozoa seems to be assured during the first days after intercourse (up to 5 days more in approximately half the cases ). There were 17 specimens with sperm cells 2-6 days after coitus, in spite of uncrystallized mucus. Fifty specimens were classified as having motile sperm, varying from one preparation with only a single oscillating sperm to those having 1- definitely motile sperm per high-power field. Two of the 52 specimens with immotile sperm showed sperm 7 days after intercourse. In the case of one of these, intercourse had taken place during menstruation on the sixth day of the cycle; abundant sperm were found, 99% of which were stained with eosin. In the remaining 124 specimens, no sperm cells were found. As the

4 VoL. 16, No. 6, SPERM VITALITY 761 TABLE 2. Distribution of Specimens According to Interval Between Coitus and Examination No. of specimens Days after coitus :Jiotile sperm Imnwtile sperm No sperm Total ToTAL TABLE. Relationship between Crystallization of Cervical Mucus and Sperm Survival Days after coitus Total No CRYSTALLIZATION Motile sperm lmmotile sperm No sperm CRYSTALLIZATION Motile sperm Immotile sperm No sperm CRYSTALLIZATION Motile sperm Immotile sperm No sperm CRYSTALLIZATION ---- Motile sperm lmmotile sperm No sperm A total of 226 specimens from 85 patients was examined.

5 762 NICHOLSON FERTILITY & STERILITY specimens were from patients who wanted to control birth by the rhythm method, we spaced examinations, especially at the beginning of the investigation, assuming that specimens taken during the period of ovulation would not contain sperm. DISCUSSION Many doctors have observed that pregnancies can result when intercourse takes place hr. before ovulation. Such suggests that spermatozoa find in the cervix, the endometrial cavity, or the tube a medium that fosters their survival and preservation of their fertilizing capacity. This must be one of the causes of failures with the Ogino-Knaus method of birth control when it is considered as a rigid mathematical formula, without evaluation of the factors which influence fecundity. Research with the use of patients who practice periodic sexual continence to control birth allows certainty about the date of the last intercourse, thus solving the primary problem which has hampered investigators in this field. 5 In a thorough investigation of the literature on this subject, we have found no report of a study using similar subjects. The fertilizing capacity of the spermatozoa found in the endocervix on various days after intercourse is unknown. Viability might be an index of fecundating capacity. Such could be assumed from the fact that the ejaculated sperm lose their motility progressively, then remain immotile for a variable time, and finally die (as indicated by the manner of staining with eosin). The observation that spermatozoa remain immotile in the epididymis for days because of low consumption of oxygen (or their immaturity) shows that they can preserve their vitality in surroundings which form natural receptacles for sperm-e.g., the endocervical canal. It is possible to find motile sperm in the endocervical canal up to 6 days after intercourse; even on the eighth day it is possible to find live but immotile sperm. The proportion of specimens with live sperm, motile or not, does not progressively decrease with increase in the time since intercourse (Table 2), as might be expected. Hence, other factors, such as the variations in cervical mucus, must exert an influence. The majority of authors agree that proper crystallization of cervical mucus favors sperm vitality. Considering the data above, it may be concluded that with 2+ and + crystallization there is a greater possibility of sustained motility or life. In some patients, sperm are present in uncrystallized mucus (or mucus just beginning to crystallize) 2-6 days after coitus, indicating that the endocervical medium has other elements favorable to sperm cells apart from the mucus.

6 VoL. 16, No. 6, SPERM VITALITY 76 Even in patients of known fertility, sperm life may be variable. In some patients motile spermatozoa are repeatedly found, 4, or 5 days after coitus, while in others, none are found hr. later. Before the sixth day of the cycle, the endocervix does not present a favorable medium for spermatozoa. CONCLUSIONS 1. Spermatozoa ejaculated in coitus occurring in the first 5 days of the cycle have few possibilities of survival. 2. Sperm are found in the endocervical canal up to 8 days after coitus.. Sperm motility and even viability may be preserved in the endocervical medium up to 6 days after coitus. 4. Crystallization of cervical mucus favors sperm survival, almost half of such specimens exhibiting sperm up to 5 days after coitus. 5. Even with no or deficient crystallization sperm may be present in the endocervical canal up to 6 days after coitus. 6. The preovular period should be studied to determine the maximum life of sperm and relate it to the time of ovulation (determined by BBT). SUMMARY From 85 fertile patients, 226 samples of endocervical contents following coitus were examined. Motile sperm were found in 50 specimens, nonmotile in 52, and none in 124. Crystallization of cervical mucus was absent in 6 samples, moderate in, greater in 55, and marked in 75. Motile sperm (some viable) were found up to 6 days after coitus; live but nonmotile up to 8 days after. Where mucus was crystallized sperm survived up to 5 days in approximately half the specimens. Even where crystallization was absent, sperm were found up to 6 days after coitus. Arroyo 881 Buenos Aires, Argentina REFERENCES 1. American Society for the Study of Sterility. Evaluation of the barren marriage. Springfield, Mass., BicKENBACH, W., and DoERING, G. Der Sterilitiit der Frau. Thieme, Stuttgart, BROWN, R. L. Rate of transport of spermia in human uterus and tubes. Am. ]. Ohst. & Gynec. 47:407, CALATRONI, C. J., Rmz, V., and m PAOLA, G. Endocrinologia Sexual Femenina. El Ateneo, Buenos Aires, 1947.

7 764 NICHOLSOK FERTILITY & STERILITY 5. CAHY, W. H. Duration of sperm cell migration in nterine secretions. Preliminary report: maximum eighty hours. ].A.M.A. 106:2221, CoHEN, ~- R., and STEIN, I. F. Sperm survival at estimated ovulation time. Comparative morphology: relative male infertility. Fertil. & Steril. 2:20, FIGUEROA CASAS, P. Investigaciones con la prueba de espermomigraci6n seriada (test de Hi.ihner). Obst. y ginec. latina-am. 18:18, FIGUEROA CASAS, P., and GoNZALEZ GAHCIA, C. Factor cervical. Valoraci6n de los metodos de diagn6stico. Obst. y ginec. latina-am. 16:58, 19" FRAENKEL, L. Sterilisierung und Konzeptionsverhi.itung. Arch; Gyniik, 144:86, HuEHNER, M. Necrospermia and viability of spermatozoa in the cervical canal. ].A.M.A. 107:1581, joel, C. A. Studien am Menschlichen Sperma. Schwabe, Basel, joel, C. A., and KoRNHAUSER, S. Influence of antibiotics on the motility of spermatozoa. Fertil. & Steril. 7:40, LANE RoBERTS, C., CHAHMAN, A., WALKER, K., and WIESNER, B. P. Sterility and Impaired Fertility. Hamish Hamilton, London, MACOMBER. Personal communication to Cary MOENCH, G. L. The longevity of the human sperm. Am. ]. Obst. & Gynec..8: 15, RocK, j. Medical progress: physiology of human conception. New England ]. Med. 240:804, RuNGE, E. Beitrag zur Aetiologie und Therapie der weiblichen Sterilitat. Arch. Gyniik. 87:572, STEIN, I. F., and CoHEN, M. R. Sperm survival at estimated ovulation time: prognostic significance. Fertil. & Steril. 1:169, TIETZE, C. Probability of pregnancy resulting from a single unprotected coitus. Fertil. & Steril. 11:485, WEINSTEIN, B. B. Discussion of Cohen and Stein WILLIAMS, w. vv., and SIMONS, F. A. Intracervical survival of spermatozoa. Am. ]. Obst. & Gynec. 4.:652, 1942.