The function of the cervix in fertility

Recent advances and new findings relative to the role of cervix in fertility are reported in this review. Cervical mucus, which may include small amounts of endometrial, tubal, and possibly, follicular secretions, is produced at a rate of 20-60 mg/day in normal reproductive age women. This rate increases up to 700 mg/day during the immediate preovulation phase. To examine the physical properties of the cervical factor, assessments should include determination of amount, viscosity, ferning, spinnbarkeit, cellularity, pH, and cultural studies, if infection is suspected. The clinical evaluation of cervical mucus properties requires evaluation of the quality of the mucus, its functional ability, and its interaction with sperm, since it now appears that sperm are stored in the cervix and are released continuously to the upper part of the reproductive tract; in addition, present evidence indicates that cervical mucus acts as a barrier or trap for sluggish and abnormal sperms. In terms of infertility assessments, postcoital tests are the most useful, and if an adequate number of motile sperm are present in the endocervix, favorable cervical factor is assumed and mucus can be ruled out as the cause of infertility.     

The importance of cauterization to maintain a healthy cervix. Long-term study from a private gynecologic practice

A total of 13,897 patients from a private gynecologic practice were retrospectively analyzed with special regard to the benefits obtained from hot linear cautery. This has been performed as an office procedure since 1937, providing unique long-term follow-up. The exposed cervical transitional zone and mild, atypical, or dysplastic cervical cytology were so treated in 6,364 patients. A significantly higher percentage of carcinoma in situ and invasive disease was found in the noncauterized cervices. With the trend of cervical intraepithelial neoplasia (CIN) toward development at an earlier age in today's population, the importance of office cauterization in preventing cervical cancer becomes apparent.     

Ovarian function after radical hysterectomy for carcinoma of the cervix

We present a prospective observational study of ovarian function following Wertheim's hysterectomy and its relationship to age at hysterectomy. Serum gonadotrophin measurements were made annually on 55 women following Wertheim's hysterectomy with ovarian preservation.
  Within 1 year of surgery four women (4/54) had biochemical evidence of ovarian failure, three of whom were over the age of 40 at operation. At 2 years eight women (8/51) had ovarian failure, seven of these women were over the age of 40 at the time of surgery. After 4 years 11 women had ovarian failure (11/34), eight of these were over the age of 40 at operation.
  Ovarian function following Wertheim's hysterectomy is well maintained in women under the age of 40 at the time of their surgery, 87% of these women had normal gonadotrophin levels 4 years after their surgery. For women over the age of 40 ovarian function is poorly maintained, with only 27% with normal gonadotrophins 4 years following surgery. These data suggest that we should carefully consider recommending bilateral oophorectomy at Wertheim's hysterectomy in women over the age of 40.     

Sexual function after conization of the uterine cervix

Conization is known to be an adequate treatment for cervical dysplasia and CIS. However, there are practically no papers on the long-term morbidity after conization. A prospective interview survey of sexual function was done with 64 patients with conizations, the follow-up period being 1 year. There was found to be a significant decrease in the number of patients with dysmenorrhea and dyspareunia and there was no change in libido, experience of orgasm, coital frequency, or in overall satisfaction of sex life. Thus, in these respects, conization is a suitable conservative method when treating dysplasia and CIS.     

The uterine lumen of the pregnant guinea-pig contains a large macrophage population

Cellular constituents of the uterine lumen were investigated. Fourteen pregnant sows of 40 + days' gestation were anaesthetized and naturally occurring peritoneal fluid was collected. A uterine horn was delivered and 0.25 ml Gey's solution injected into the uterine lumen to collect free cells. The fluid was aspirated into a syringe and the cells extracted, counted and prepared for phagocytosis experiments and microscopy. The cells were stained with alpha-naphthyl-acetate-esterase (ANAE) to determine the fraction that was non-specific esterase-positive, a feature of mononuclear phagocytes. Differential cells counts were also made. Both uterine and peritoneal compartments yielded large numbers of cells (greater than 10(6)/ml). Peritoneal fluid cells were 47 +/- 6 per cent (SD) macrophages and 49 +/- 6 per cent eosinophils (the remainder being 'other' cells); 47 +/- 6 per cent also stained positively for ANAE. Uterine cells were 78 +/- 12 per cent macrophages, the remainder being mostly lymphocytes (18 +/- 11 per cent); 85 +/- 13 per cent stained positively with ANAE. Electron microscopy of the uterine cells confirmed that most had morphology consistent with being mononuclear phagocytes. Uterine and peritoneal cells phagocytized carbon particles and yeast cells when incubated at 37 degrees C. The origin and role of this macrophage population is unknown but uterine lumenal macrophages may be present to remove antigen-antibody complexes thus facilitating uptake of maternally derived IgG by the fetal yolk sac.     

The importance of extensive sampling and examination of cervix in suspected cases of amniotic fluid embolism

Amniotic fluid embolism is an important complication of pregnancy with high mortality. The diagnosis of amniotic fluid embolism is generally made postmortem and rests upon the histological demonstration of amniotic fluid debris, including foetal epithelial squames and hair, in the pulmonary vasculature. We have made the diagnosis of amniotic fluid embolism in two patients by detection of the amniotic fluid debris in the blood vessels of the cervix in their hysterectomy specimens. These two patients presented with profuse primary postpartum haemorrhage and evidence of disseminated intravascular coagulation after uneventful deliveries. Amniotic fluid debris were only demonstrated in the blood vessels of the cervix but not in the corpus. This observation emphasizes the importance of a thorough histological examination of the cervix in cases of suspected amniotic fluid embolism. Received: 28 January 1994 / Accepted: 6 April 1994     

Ovarian function after radical hysterectomy for stage IB carcinoma of cervix

Ovarian function was assessed in 20 patients after radical hysterectomy and lymph node dissection for Stage IB cervical carcinoma. All patients were under 45 years of age, and four were or had been on estrogen therapy for postmenopausal symptoms. The other 16 patients were free of symptoms and demonstrated premenopausal gonadotropin profiles. Fourteen of these 16 had luteal phase serum progesterone levels. Only one patient required reoperation for a pathologic condition of the adnexa. A surgical approach to Stage IB cervical carcinoma conserves ovarian function in 80% of patients.