A modified in vitro spermatozoal penetration test. II. Application in fertility investigations.

Abstract

A modified in vitro spermatozoal test was applied to fertility investigations of 70 infertile couples with an average 7-year duration of infertility. 60% had primary infertility and 40% secondary infertility. When histories and other tests failed to provide adequate reasons for the infertility a modified in vitro test which measures the ability of spermatozoa to penetrate cervical mucus and the physical and chemical properties of the mucus was developed. In cases of spermatozoal-mucus incompatibility the test also determines the specificity of the incompatibility. After pretreatment with ethinyl estradiol for 7-17 days cervical mucus was collected and drawn into hematocrit tubes. These were then placed vertically in test tubes containing .5 ml of fresh semen. Examinations for sperm penetration were made after 90 minutes incubation. Cross examinations with donor sperm or donor mucus were also done. Postcoital tests were done in some cases. 43 (61.3%) of the couples investigated had normal spermatozoal penetration and 19 (28.3%) showed poor penetration. Cervical mucus pathology was found in 8 cases. In 2 instances both poor penetration and abnormal mucus were present. A specific mucus-spermatozoal imcompatibility between the wifes mucus and the husbandss semen was demonstrated in only 1 case but may have been a factor in 5 others. In 18.2% of the cases these tests detected unsuspected semen or mucus pathology. There was good correlation with the postcoital tests when they were reported as good or excellent but no consistent correlation when reported as fair or negative. This modified test is considered valuable and is simple enough to be carried out in a clinical laboratory. The results are expressed in quantitative terms thus enabling comparison and statistical evaluation.