Tipos de secreción cervical Prof Erik Odeblad

Emérito Dept. of Medical Biophysics. University of Umea. Suecia.

Lee la ponencia Mikaela Menárguez (en la foto)

VIII Symposium Internacional sobre Regulación Natural

de la Fertilidad: Aplicaciones a la

Salud Reproductiva

TYPES OF CERVICAL SECRETION

Dr. Erik Odeblad, Dr. Axel Ingelman-Sundberg, Dr. Mikaela Menárguez, Dr. Helvia Temprano, Dña. Sode Pouyanmehr, Dr. Pilar Vigil, Dr. Mary Martín and

Dr. Astrid Höglund

ABSTRACT

The first time cervical mucus was mentioned in the medical literature occurred, to our knowledge, in the middle of the 19th century (13, 14). In the 1930s, the period of abundant and strechy mucus (“glaire filante”) became related to ovulation (12). In 1948 it was shown (11) that this type of mucus came out with beatiful crystals if it was allowed to dry on a microscopic slide without any staining or histo-chemical test. That was an important discovery because it permitted reserchers to permanently store original mucus, provided the slides were kept free from dust and moisture. In other phases of the cycle very small, or no crystals occurred, instead there were thick mucus with plenty of cells. At that time it was generally believed that all the cervical crypts changed their secretion in synchronism during the cycle, but in 1966 it was shown (6) that some crypts were responsible for the thin, crystallizing mucus and other crypts for the thick, non-crystallizing secretion. These two types of mucus were called E (estrogenic) and G (gestagenic).

In 1977 it was demonstrated that the E type contained two components side by side in the cervical canal. These were denoted S (sperm conducting) and L (locking in low-quality spermatozoa). The S type crystallized with tiny, parallell crystal formations (Fig. 4 and 9), the L type with large rectangularly branching crystals. The G, L and S types were subjected to continuing studies (15). In 1992 an additional type, present in less amount, was described, denoted P because it seemed to have a maximum at the peak fertility day (7). It was soon divided in two subtypes, P6 with pretty star-like crystals with 6-fold symmetry and P2 with 2-fold symmetry, P2 being more common a few days before ovulation. The P types have 60 degree branching angles in contrast to the rectangular branching of the L mucus.

Table I gives a compilation of important properties of the various types, and Fig. 10 describes the reproductive importance of the cervix.

The two subtypes P2 and P6 seem to have quite different functions. P2 seems to carry mucolytic grains which originate in the isthmus glands, P6 seems to contribute to selection of ascending sperm. All these various mucus types and subtypes have been subjected to careful studies with electron microscopy (5, 16). The pictures we can see in a common microscope are shown in Fig. 4, and the sites of mucus production and presence in the cervical canal are shown in Fig. 1, 2 and 8.

The practical application of the research on the cervix is of course strongly related to the Billings method of NFP (1, 2), and there is a continuous exchange of results and ideas between research and practical work. In recent years also fertility disorders have come into this area (17) and there are a lot of interesting problems open for research. Deviation from normal cyclic curves for various mucus types (Fig. 7), ongoing cell-

biologic studies (Fig. 5 and 6) and improvement and training of mucus sampling (Fig. 3) are some suggestions for future activities in this field.

Finally we would like to point out that cervix is an organ with complex biology and very precise functions which are sensitive to external factors such as hormonal effects and infections. Maintenance of reproductive health must also consider these problems, women have the right to have a healthy cervix as part of her reproductive health so research on the cervix is an important part of that work.

References

1. Billings, E.: The Billings Method, Revised ed., 2000. Penguin Books, Australia.

2. Nillings, J.: The Ovulation Method. Advocate Press Pty, Ltd, Melbourne, 1983.

3. Fluhmann, C.F.: The cervix uteri and its diseases, Saunders Co Philadelpphia 1961

4. Höglund, A. & Odeblad, E.: Sperm penetration in cervical mucus, A biophysiucal and group. theoretical approach. In: The uterine cervix in reproduction, Workshop conference Rottach-Egern 1977.

5. Menárguez, M.: Caracterización morfológica de diversos tipos de moco cervical humano mediante microscopía de luz y microscopía electrónica de barrido. Tesis, Murcia, 1998.

6. Odeblad, E.: Micro-NMR in high permanent magnetic fields. Acta Obst. Gyn, Scand. 45, suppl. 2. 1966.

7. Odeblad, E.: Recent research on cervical mucus. Avanc. Regul. Nat. Fer. Univ. Málaga, 1992 (printed 1994). 88-91.

8. Odeblad, E.: The discovery of different tupes of cervical mucus and the Billings Ovulation Method. Bull. Nat. Fam. Plan. Council Victoria 21. nº 3-35, 1994.

9. Odeblad, E. Cervical mucus and their functions. J. Irish coll. Physicians and Curg, 26, nº 21, 27-32, 1997.

10. Odeblad, E. & al.: Cervical mucus type P6, structure, variability and posible functions. VII Symp, Internac. Regul. Nat. Fert. 18-20 Marzo 2004, Univ. Int. de Cat. Barcelona.

11. Rydberg, E.: Observations on the crystallization of the cervical mucus. Acta Obst, Gyn. Scand. 28: 172-187, 1948.

12. Seguy, J. and Simmonet, H.: Recherche de signes directs d’ovulation chez la femme. Gynec. et Obstet. 28, 657-663, 1933

13. Sims, J. M.: Illustration of the values of the microscope in the treatment of the sterile condition. Brit. J. Med, 465-466, and 492-494, 1868.

14. Smith, W. T.: The pathology and treatment of leucorrhea. Edit. Churchill, London 1855.

15. Temprano, H.: Estudio de los parámetros biofísicos del moco cervical humano e investigación de la cristalización con microscopio óptico y electrónico. Influencia de los inductores de ovulación. Tesis Univ. de Santiago de Compostela, 1990

16. Temprano, H. & al.: Tipos de moco cervical e identificación de elementos al microscopio electrónico de barrido. Resultados preliminares. Proc. IV Symp. Int. Sobre Regulación Natural de la Fertilidad. Oct. 6-8, 1994, pp. 304-305. Colegio Oficial de Médicos. Barcelona.

17. Vigil. P.: Fertility disorders and the Billings Ovulation method Res. and Ref. Centre of Victoria 30, nº 3, p 4-10. 2003

Prof. Erik Odeblad

PROBABLE OR SHOWN FUNCTIONS OF THE DIFFERENT TYPES OF SECRETION

G mucus: A barrier for sperm due to the dense macromolecular network. Antimicrobial action due to leucocytes, lymphocytes, macrophages and immunoglobulins A and G.

S mucus: High-quality sperm propagates easily in the liquid phase, which flows between the macromolecular chains, orienting sperm upwards. Low-quality sperm (slow swimmers and malformed sperm) seem to deviate in lateral trajectories and enter the surrounding L mucus.

L mucus: It forms a flexible mechanical support for the fluid S mucus. It catches low-quality sperm. The L and S mucus types form together a sperm-sorting system

P2 mucus: It seems to carry mucolytic enzyme(s) which are produced in the Z secretion from the isthmus glands and/or possibly from the endometrium or tubes.

P6 mucus: It is secreted by members of a cell line Pn ⇒ Pi ⇒ Pt. The secretion from Pt cells polymerizes and appears as P6 crystals. The secretions from Pn and Pi cells may have the property to recognize and adhere to those low-quality sperm which are not eliminated by the L-S sperm sorting system.

Prof. Erik Odeblad

Location and important connections of the female reproductive system.

Prof. Erik Odeblad

Indicating the different zones in the cervix where the various mucus types are produced.

Prof. Erik Odeblad

Indicating how a mucus simple is removed from the cervical canal, smeared out, dried and examined in the microscope.

Prof. Erik Odeblad

Microphotographs on mucus types. L, P2, S and P6 are magnified 280 X. Mucus G has 720 X magnification for visualizing cells, the secretion Z from the isthmus has 1800 X magnification to

show enzyme.containing zymogen granules.

Prof. Erik Odeblad

Indicating the cycle variations. Various mucus types are indicated by different letters and colours.

Prof. Erik Odeblad

Microphotos of Pn, Pi and Pt cells, 1800 X

Prof. Erik Odeblad

Stereomicrophos of an encounter between an R cells and a Pi cells, A Schematic drawing helps to explain the relation between de cells.

Prof. Erik Odeblad

The structural localization of various mucus types in the cervix on the day of ovulation. Mucus types given in colours.

Prof. Erik Odeblad

A sperm cell propagating between two molecular filaments of F mucus.

Prof. Erik Odeblad

The various steps of propagation and selection of spermatozoa from the sperm deposit near the cervix, through the cervix, and up to the tubers. Only aproximate numbers are available for the

various processes.