Biochemical changes in cervical mucus-factor infertility

Cervical-factor infertility has generally been attributed to the presence of antispermatozoal antibodies in the secretions of the uterine cervix, despite the fact that the incidence of sperm-specific antibodies in these women is generally low. We report here a modification in the structure of the cervical mucus of patients with a diagnosed cervical factor. Cervical mucus from patients with a cervical factor of nonimmunological origin, collected during the periovulatory phase of the menstrual cycle, had (1) a significant decrease in the content of glycosidically bound sialic acid and (2) an increased ability to act as an acceptor for sialic acid from cytidine-5′-monophospho-N-acetylneuraminic acid (CMP-sialic acid) when incubated with an exogenous sialyltransferase; in comparison to mucus from normal fertile women. Both siaiyltransferase and fucosyltransferase activities were detected in cervical mucus, but there was no difference between fertile normal and cervical-factor patients using the assays described. These results reinforce a possible role for sialic acid residues and their associated glycosyltransferases in the regulation of spermatozoal–cervical mucus interaction.     

Composition and function of human cervical mucus

Human cervical mucus was collected from seven donors during the follicular, ovulatory and luteal phases of the ovulatory menstrual cycle. Individual mucus samples were solubilized and fractionated on Sepharose columns into excluded mucins and low-molecular-weight proteins. Mucin fractions were highly purified, as evidenced by the presence of a single N-terminal amino acid residue, threonine, and by the absence of contaminating plasma proteins. Amino acid compositions of mucins isolated during different menstrual phases of a single donor or from different donors were similar. Mucin carbohydrate compositions were also similar, except for the sialic acid-to-fucose ratio, which varied significantly between donors but not within the menstrual cycle of a single donor. An analysis of variance was applied to evaluate the contribution of mucin composition to viscoelasticity, as quantitated by microrheometry. Viscoelasticity was dependent on the donor, on the percent nondialyzable solids and on the mucin content, but not on the phase of the menstrual cycle during which the sample was collected. These findings suggest that mucus function (viscoelasticity) is reflected in carbohydrate composition and/or structure and that this menstrual relationship is unique for each donor. Furthermore, the absence of menstrual phase-dependent differences in mucins suggests that mucin concentration and not composition changes in response to alterations in the hormonal milieu.     

Sex steroids in cervical mucus of spontaneous or induced ovulatory cycles

Evaluation of sex steroids in cervical mucus was performed at different phases of spontaneous or clomiphene-citrate-induced ovulatory cycles. To this end, 11 women with normal ovulatory cycles and 9 subjects with polycystic ovary syndrome of comparable age and body mass index were investigated. Serum and cervical mucus samplings were assessed for 17beta-estradiol (E2), progesterone, testosterone, and sex hormone binding globulin levels at the pre-, peri-ovulatory, and mid-luteal phases of the cycle. The cervical mucus maturation index also was estimated in all women. Measurable amounts of E2 were found in most mucus samples with a cyclic variation in all cases. The highest E2 and mucus maturation index values coincided, but both lagged by 24 h behind the serum mid-cycle peak of this steroid. Detectable amounts of progesterone were found in the luteal phase, testosterone was present at low levels throughout the cycle, but sex hormone binding globulin was undetectable in all cervical mucus samples. Differences between spontaneous or drug-induced ovulatory cycles were not found. It is concluded that sex steroids are present in human cervical mucus, showing variations similar to those in peripheral blood. The significance of these findings is not clear at present, but it is probably related to the cyclic changes of cervical epithelium and gland secretion. An important implication of the absence of measurable sex hormone binding globulin amounts in cervical mucus is that the free fraction of sex steroids present in that fluid are presumably higher, and therefore, expected to exert greater biologic activity than in peripheral blood.     

Interpretation of single progesterone measurement in diagnosis of anovulation and defective luteal phase: observations on analysis of the normal range.

Single serum progesterone determinations were made in 79 apparently normal women with a regular menstrual cycle. A normal range (40 subjects) was derived from the concentrations in the follicular phase and used to define an "anovular" range for luteal phase values (nine out of 39 subjects). The remaining luteal phase values were used to construct an "ovular" range for the luteal phase and, within this range, to define a group of values (less than the 20th centile) which could be described as a "defective luteal phase." The cut off limits between ovular and anovular and between normal and defective luteal phases were respectively two and four times the follicular phase median. It is proposed that the numerical findings of this study may be used as a rule of thumb for defining normality and abnormality from a single serum progesterone determination.     

Endometrial content of prostaglandin precursors during the menstrual cycle

Fractionated curettage was performed in 18 women with cervical intraepithelial neoplasia. Otherwise all appeared to be healthy. The histological examination showed 9 of them to have been sampled in the follicular phase and the other 9 in the luteal phase. Endometrial specimens were simultaneously taken for analysis of the fatty acid pattern of lecithin (PC) and phosphatidylethanolamine (PE) by means of gas-liquid chromatography (GLC). In the luteal phase we found increased concentrations of the total sum of essential fatty acids of the linoleic acid series both in PC and PE (p less than 0.01 in both cases). All the main fatty acid components within this series showed increased mean levels in the luteal phase but only arachidonic acid (20:4) in PE was significantly elevated (p less than 0.01). The total sum of the alpha-linolenic acid series was unaffected by the phase of menstrual cycle. These results seem to indicate that the endometrium accumulates prostaglandin precursors towards the time for menstruation.     

On the role of sialic acid in the rheological properties of mucus.

The importance of sialic acid in the rheological properties of mucus has been investigated. Both bovine cervical mucus, which is a gel, and the structural glycoprotein derived from it were studied before and after treatment with neuraminidase which selectively cleaves terminal sialic acid residues. The storage modulus, viscosity and circular dichroism spectrum were all essentially changed after removal of the sialic acid. These results would indicate that removal of sialic acid does not affect the physical structure of the glycoprotein and it is concluded that sialic acid has no significant role in the rheological properties of cervical mucus.     

Correlation of gastric mucosal damage with sialic acid profile in rats: effect of hydrochloric acid, pepsin and hypertonic saline

Sialic acids occupy terminal positions on gastric mucus glycoprotein where they contribute to the high viscosity of mucin. Desialylation of mucus may lead to degradation of the mucus and eventually to the breakdown of the gastric mucus barrier. The effect of a variety of damaging agents (0.1 M HCl, 2 mg ml(-1) pepsin and 2 M NaCl) on sialic acid profile was determined in pylorus-ligated rats. The relationship between sialic acid, galactose, pyruvate and the extent of gastric mucosal damage were studied. Instillation of pepsin significantly increased total sialic acid, galactose and macroscopic mucosal lesions in the stomach. Instillation of 0.1 M HCl reduced the total sialic acid but this decrease was not significant. Acidity led to a significant increase in the amount of free sialic acid in the gastric instillates and the macroscopic lesions induced by acid was not significantly different from the control animals (0.15 M NaCl). 2 M NaCl induced the macroscopic lesions in the stomach and also free sialic acid in the instillates. Pepsin potentiates the action of 2 M NaCl. In all the agents examined with the exception of acid, it was observed that an increase in free sialic acid and galactose was accompanied by gastric mucosal erosion and elevation of pyruvate concentration. It is concluded that gastric acidity alone is not inherently damaging and that resistance of gastric mucosa to destructive agents may be dependent on the integrity of the sialic acids.     

Chlamydia Detection during the Menstrual Cycle: A Cross-Sectional Study of Women Attending a Sexual Health Service

Background

We investigated the detection of chlamydia at different stages of the menstrual cycle.

Methods

Electronic medical records for women attending Melbourne Sexual Health Centre between March 2011 and 31^st December 2012, who were tested for chlamydia by nucleic acid amplification of high vaginal, cervical, or urinary samples, and who recorded a date of last normal menstrual period (LNMP) between 0–28 days were included in the analysis. Logistic regression was used to calculate adjusted odds ratio (aOR) and 95% confidence intervals (CI) for the association of chlamydia with menstrual cycle adjusted by demographics and behavioural variables. Chlamydia and beta globin load were determined on those with stored samples.

Results

Of the 10,017 consultations that included a test for chlamydia and a valid LNMP, there were 417 in which chlamydia was detected. The proportion of samples with chlamydia was greater in the luteal phase (4.8%, 184/3831) than in the follicular phase (3.4%, 233/6816) both in the crude (OR 1.29 95%CI 1.1–1.6, p = 0.01) and adjusted odds ratio (aOR) 1.4 (95%CI 1.1–1.8, p = 0.004). Among women using hormonal contraception, there was no significant association with the luteal phase of the menstrual cycle (aOR 1.3, 95%CI 0.9, 1.8, p = 0.18). Among women not using hormonal contraception, there was a significant association with the luteal phase (aOR 1.6, (95% CI 1.1–2.3, p = 0.007). The chlamydia load was not significantly different in the 329 positive stored samples in weeks 3 and 4 vs weeks 1 and 2 for any site (P>0.12).

Conclusions

The higher detection of chlamydia detection in the luteal phase of the menstrual cycle in only those not taking hormonal contraception suggest that hormonal factors influence chlamydia detection. The absence of a significantly highly chlamydia load in women during the luteal phase raises questions about the mechanism.     

The influence of cystic fibrosis serum and calcium on secretion in the rabbit tracheal mucociliary apparatus.

Cystic Fibrosis serum or its isolated component IgG fraction and calcium ionophore A23187 all produced a quantitatively greater increase of mucus glycoprotein secretion in the rabbit tracheal epithelium than did control serum or its isolated component IgG fraction. These values were determined by dry weight secretion per gram of tissue and on subsequent sialic acid content of secretions. This demonstrable increase in mucus production represents a measurable difference in the functioning of the cultured mucociliary apparatus due to the influence of cystic fibrosis serum.     

Influence of hormonal contraceptives on the pituitary response to LH/FSH-releasing hormone.

In the pre-ovulatory phase the absolute and relative LH increase was much greater than during the luteal phase and less pronounced in the early follicular phase of the normal cycle. FSH release was affected only during the pre-ovulatory period, where a retarded, 3- or 4-fold increase compared to basal levels was recorded. In the women taking oral contraceptives of the conventional type the first LH-RH test showed gonadotropin responses similar to those obtained during the luteal phase of the controls. The second test brought a significantly lower LH response, suggesting an increasing exogenous steroid inhibition at the pituitary level in the course of the therapeutic cycle. This inhibition seems to be reversed during the monthly tablet-free interval. A particularly small and retarded gonadotropin response was observed in patients taking Deposiston. These results are discussed as to their clinical significance.     

The endocervical smear as a simple and quick method for the determination of ovulation

The endocervix undergoes cyclic changes in every menstrual cycle, as reflected by the rheologic properties of the cervical mucus. A study was therefore undertaken to establish whether there were any morphologic changes in the endocervical columnar cells, as seen in the endocervical smears, that could be correlated with ovulation and anovulation. An endocervical smear was collected in the luteal phase of the cycle from patients in whom an endometrial biopsy or D & C was being done as a part of an infertility investigation. A significant correlation was observed between the endocervical smear interpretation and the endometrial histology as to whether the cycle was ovulatory or anovulatory.     

Effect of menstrual cycle phase on the ventilatory response to rising body temperature during exercise

To examine the effect of menstrual cycle on the ventilatory sensitivity to rising body temperature, ten healthy women exercised for ~60 min on a cycle ergometer at 50% of peak oxygen uptake during the follicular and luteal phases of their cycle. Esophageal temperature, mean skin temperature, mean body temperature, minute ventilation, and tidal volume were all significantly higher at baseline and during exercise in the luteal phase than the follicular phase. On the other hand, end-tidal partial pressure of carbon dioxide was significantly lower during exercise in the luteal phase than the follicular phase. Plotting ventilatory parameters against esophageal temperature revealed there to be no significant menstrual cycle-related differences in the slopes or intercepts of the regression lines, although minute ventilation and tidal volume did significantly differ during exercise with mild hyperthermia. To evaluate the cutaneous vasodilatory response, relative laser-Doppler flowmetry values were plotted against mean body temperature, which revealed that the mean body temperature threshold for cutaneous vasodilation was significantly higher in the luteal phase than the follicular phase, but there were no significant differences in the sensitivity or peak values. These results suggest that the menstrual cycle phase influences the cutaneous vasodilatory response during exercise and the ventilatory response at rest and during exercise with mild hyperthermia, but it does not influence ventilatory responses during exercise with moderate hyperthermia.     

Sialo proteins and phosphatases in estrual cervical mucus of fertile and repeat breeder buffaloes (Bubalus bubalis )

Concentrations of sialic acid and protein and activities of acid phosphatase (ACP) and alkaline phosphatase (AKP) were determined in estrual cervical mucus of fertile and repeat breeder buffaloes during late estrus. Significantly (P < 0.01) higher concentrations of sialic acid and ACP and AKP activities were observed in fertile buffaloes as compared with repeat breeder buffaloes. However, differences were nonsignificant in protein content between fertile and repeat breeder buffaloes, albeit protein concentration was higher in fertile buffaloes. The significance of sialoproteins and phosphatases in fertility has been clarified.     

Modulation of gastric mucosal calcium channel activity by mucus glycoprotein

• 1.1. The effect of gastric mucus glycoprotein on the activity of calcium channel isolated from gastric epithelial cell membrane was investigated. The ⁴⁵Ca²⁺ uptake into the vesicle-reconstituted channels, while only moderately (14%) affected by the intact mucus glycoprotein, was found significantly inhibited (59%) by the acidic glycoprotein fraction. This effect was associated with the sialic acid and sulfate ester groups of the glycoprotein, as their removal caused a loss in the inhibition.
• 2.2. The channel complex in the presence of epidermal growth factor (EGF) and ATP responded by an increase in protein tyrosine phosphorylation of 55 and 170 kDa proteins, and the vesicles containing the phosphorylated channels showed a 50% increase in ⁴⁵Ca²⁺ uptake. The phosphorylation and the calcium uptake were susceptible to inhibition by a specific tyrosine kinase inhibitor, genistein.
• 3.3. The channel protein phosphorylation was inhibited by the acidic mucus glycoprotein, which also interfered with the binding of EGF to the channel protein. The inhibitory effect was dependent upon the presence of sulfate ester and sialic acid groups, as evidenced by the loss of the glycoprotein inhibitory capacity following their removal.
• 4.4. The results suggest that the acidic gastric mucus glycoproteins, by modulating the EGF-controlled calcium channel phosphorylation, play a major role in gastric mucosal calcium homeostasis.

     

Changes in ganglioside contents, plasma sialic acid and cAMP levels in experimental hepatoma in mice

The present study was designed to assess whether changes in glycolipids and cyclic AMP contents might serve as markers for the diagnosis of malignancy in the liver. The experimental model was a transplantable murine hepatoma. Experimental mice were divided into three groups: (1) a therapeutic group, which had been transplanted with hepatoma and treated with the antimetabolism drug 5-flurouracil (0.2 mg/day i.p.), (2) a control group, which had been transplanted with hepatoma and treated with 0.2 ml 0.9% NaCl/day and (3) a normal group of mice. The ganglioside and cAMP contents in the hepatoma tissue, plasma cAMP, total- and lipid-bound sialic acid levels and red blood cell membrane sialic acid levels were determined. Results showed that the ganglioside content, total and lipid-bound sialic acid levels in the control group were significantly higher than those in the livers of normal mice (p < 0.01) while these respective values in the therapeutic group were significantly lower than those in the control group (p < 0.01). The cAMP levels of tumor tissues and plasma in the control group were lower than those in normal mice. No significant difference in red blood cell membrane sialic acid content was observed between the therapeutic and control groups though levels for both were higher than those in normal mice. These results indicate that ganglioside content and sialic acid levels in hepatoma tissues were significantly elevated, and cAMP levels in hepatoma tissues were significantly decreased during proliferation and abnormal differentiation.     

Non-fertility in cows with an abnormal indole metabolism and disturbed carbohydrate composition in the cervical mucus: a preliminary report

Cervical mucus samples of the cow appear to provide information on the probability of becoming pregnant. In six 'repeat breeders' a strong indole metabolism was found in the cervix. When luteal tissue was decreasing and follicles increasing, compounds were found indicating possible exfoliation of the endometrium, which in dogs is a normal process in late metoestrus. Exfoliation of the endometrium was actually demonstrated in two cows after slaughter. It can delay the onset of oestrus for several days and can disturb implantation of an embryo. The carbohydrate composition of the cervical mucus was also different from that in normal cows. Treatment with PMSG and PGF resulted only twice in the formation of glucuronic acid and sorbitol, which are seemingly necessary for the receipt of spermatozoa. A disturbed carbohydrate composition and an abnormal indole metabolism, which is easily detectable in the cervical mucus, may prevent or disturb fertilization in cows.     

Physical properties of bovine cervical mucus during normal and induced (progesterone and/or PGF2alpha) estrus

Ninety two Friesian cows were used to determine physical properties of cervical mucus collected during normal estrus and estrus induced. Estrus was induced using either progesterone (P4) releasing intravaginal devices (PRID) and/or prostaglandin F2alpha (PGF2alpha). The animals were assigned to 4 groups (no treatment, a PRID for 12 days plus an injection of 1000 IU PMSG at the removal of the PRID, a double injection of 3 mL PGF2alpha 11 days apart, and a PRID for 7 days plus an injection of PGF2alpha 24 h before the removal of PRID). A number of cows with normal estrus exhibited three consecutive estrus cycles after calving. Cows that had not shown estrus for three months after calving had their reproductive system palpated twice at 10-day intervals, to determine their ovarian activity. Then PRID and/or PGF2alpha was administered to cows that were found to have a palpable corpus luteum in one of two palpations (cycling cows). The cows of the three induced estrous groups were artificially inseminated (AI) twice, while those with normal estrus received only a single AI. Cervical mucus samples were collected from all cows 5 to 30 min before the first AI. Additionally, samples of cervical mucus were collected from 20 cows at their first estrus after the induced estrus. The results are summarized as follows: 1) The physical properties of cervical mucus were similar in the first three normal consecutive estrus cycles after calving. 2) The physical properties of cervical mucus in normal estrus after calving were similar to those in the first estrus after an induced estrus. 3) The pH values for normal estrus were similar to those for induced estrus. 4) Viscosity of cervical mucus in the normal estrous group was significantly lower than that in the induced estrus. Furthermore, significant differences were noticed among the three induced estrous groups. 5) Spinnbarkeit, crystallization and receptivity of cervical mucus (penetration test) were significantly higher in the normal estrous group than in the induced estrous groups, while no difference was detected among induced estrus groups. 6) Pregnancy rates in the normal estrus group were the same as in the induced estrus groups. 7) The percentages of cows in the induced estrous groups that produced cervical mucus with similar viscosity, spinnbarkeit and receptivity (penetration test) characteristics as the normal estrus group, was very low.     

Non-fertility in cows: treatment with PGF and investigation of uterine biopsies

Experiments with seventeen 'repeat breeders' confirmed that the carbohydrate composition, the hormonal pattern, the cholesterol content and the occurrence of indole metabolites, such as blue fluorescing protein, in cervical mucus can be used as parameters for the fertilizing capacity of these cows. After careful rectal examination 25 mg PGF2 alpha was administered to thirteen 'repeat breeders' on that day of the luteal phase when next to the corpus luteum no follicle was palpable; ten of them became pregnant or were fertilized. Uterine biopsies were taken from eight 'normal' cows and from eight 'repeat breeders', simultaneously with cervical mucus samples. The biochemical composition of the biopsies was comparable to that of the mucus samples. The taking of two biopsies produced injurious consequences for the animals, perceptible in oestrous behaviour. Investigation of cervical mucus samples is therefore preferred to uterine biopsies for the examination of sterility in cows.     

Lipid metabolism and coagulation during the normal menstrual cycle

To examine the effects of sex-hormones on lipids, lipoproteins and coagulation in the normal menstrual cycle 37 women had blood samples taken early in the follicular phase (low estrogen) at the midcycle (high estrogen) and late in the luteal phase (high estrogen and high progesterone) under the best possible uniform and basal conditions. No significant changes (P greater than 0.05) in lipids and lipoproteins (including the HDL subfractions and apolipoproteins) were found throughout the menstrual cycle. In the coagulation system antithrombin III and factor VII did not change (P greater than 0.05). Fibrinogen, however, showed a significant (P less than 0.05) increase in the luteal phase compared to the follicular phase and midcycle. Fibrinogen showed a significant positive correlation (r = 0.2766; P less than 0.01) with progesterone, so the rise in fibrinogen in the luteal phase could be a progesterone effect. This longitudinal study performed on a large number of women under basal conditions showed that it seems of minor importance to define exact days of the cycle for analysing lipids and lipoproteins e.g. as controls in a study of lipid metabolism in women taking sex-hormones. For coagulation studies the cycle days may, however, be of importance.     

Large scale identification of proteins, mucins, and their O-glycosylation in the endocervical mucus during the menstrual cycle

The mucus filling the human cervical opening blocks the entry to the uterus, but this has to be relative and allow for the sperm to penetrate at ovulation. We studied this mucus, its content of proteins and mucins, and the mucin O-glycosylation in cervical secretions before, during, and after ovulation. Cervical mucosal secretions from 12 subjects were collected, reduced-alkylated, separated with polyacrylamide or agarose/polyacrylamide gel electrophoresis, and stained with silver, Alcian blue, or Coomassie Blue stain. Protein and mucin bands from before and during ovulation were digested and subsequently analyzed by nano-LC-FT-ICR MS and MS/MS. We identified 194 proteins after searches against the NCBI non-redundant protein database and an in-house mucin database. Three gel-forming (MUC5B, MUC5AC, and MUC6) and two transmembrane mucins (MUC16 and MUC1) were identified. For the analysis of mucin O-glycosylation, separated mucins from six individuals were blotted to PVDF membranes, and the O-glycans were released by reductive beta-elimination and analyzed with capillary HPLC-MS and -MS/MS. At least 50 neutral, sialic acid-, and sulfate-containing oligosaccharides were found. An increase of GlcNAc-6GalNAcol Core 2 structures and a relative decrease of NeuAc residues are typical for ovulation, and NeuAc-6GalNAcol and NeuAc-3Gal- epitopes are typical for the non-ovulatory phases. The cervical mucus at ovulation is thus characterized by a relative increase in neutral fucosylated oligosaccharides. This comprehensive characterization of the mucus during the menstrual cycle suggests mucin glycosylation as the major alteration at ovulation, but the relation to the altered physicochemical properties and sperm penetrability is still not understood.