Skip to main content
Download PDF
  • Spermiologie
  • Published:

Place des tests d’interaction sperme-mucus dans le bilan masculin de l’infécondité

Sperm-Mucus interaction tests in male infertility work-up

Andrologie volume 8, pages 36–46 (1998)Cite this article

Resumé

Il est souvent nécessaire de faire une analyse fine du pouvoir fécondant des spermatozoïdes chez des couples infertiles. Le mucus cervical protège les spermatozoïdes et permet leur survie, assurant, à l’ovulation, une ascension continue de spermatozoïdes dans les voies génitales de la femme. Le test post-coïtal a longtemps été la seule épreuve fonctionnelle des spermatozoïdes. Il teste la pénétration et la survie des spermatozoïdes dans la glaire cervicale, les premieres d’une longue série d’étapes que doivent parcourir les gamètes mâles dans leur ascension vers l’ovule. Mais le TPC n’est pas dépourvu d’implications émotives et doit se faire le plus simplement possible pour éviter des inhibitions sexuelles. Dans les conditions optimales, le nombre de spermatozoïdes mobiles dans la glaire de l’endocol corrèle bien avec l’analyse du sperme et avec les chances de grossesses. En présence d’anticorps antispermatiques, on ne trouve au TPC que fort peu de spermatozoïdes en contraste avec la qualité de l’éjaculat ou beaucoup, mais immobiles ou agités. On peut aussi faire des tests in-vitro, (techniques de Kurzrok ou de Kremer) avec une glaire humaine ou avec des substituts bovins ou synthétiques. Ces épreuves évaluent bien la qualité du sperme mais ne corrèlent que partiellement avec le TPC naturel en raison de la nature complexe de la fonction du col utérin. Dans un groupe de FIV que nous avons analysé, le TPC corrèle avec les taux de fécondations et de grossesses en FIV et contribue à dépister le groupe à haut risque dans lequel des examens complémentaires peuvent trier les couples relevant de micro-injection. Cependant, le TPC a été critiqué pour sa méthodologie et surtout pour sa faible validité. Dans notre groupe de FIV, l’analyse de la validité du TPC et de tous les autres éléments d’appréciation de la qualité du sperme vis à vis des fécondations et grossesses confirme cette faible validité et montre qu’elle est commune à tous ces éléments d’appréciation, sans doute à cause de la nature multifactorielle du pouvoir fécondant des spermatozoïdes. L’analyse multifactorielle montre néanmoins que le TPC tient une place de premier plan parmi les examens pratiqués. Ainsi, l’évaluation du pouvoir fécondant des spermatozoïdes ne peut se fonder sur aucune épreuve isolée. Elle requiert une cascade judicieuse d’examens et c’est à leur lumière que l’on peut dresser un bilan valable et décider du geste thérapeutique rationnel.

Abstract

In infertile couples, it may be necessary to finely analyze the fertilization ability of spermatozoa. The postcoital test (PCT) has long been the only sperm functional assay. It tests the sperm penetration and survival ability in the cervical mucus. These are the first steps of a long cascade of events that spermatozoa have to undergo during their ascension in the female genital tract, on their way to the site of fertilization. However, the PCT may evoke emotional stress and should be done in a simple way to avoid sexual inhibitions. In optimal conditions, the number of motile spermatozoa seen in the upper cervical mucus correlates well with semen analysis and the odds of subsequent pregnancies. Antisperm antibodies may impair the PCT and only few, if at all, or many immobile or shaking spermatozoa, may be seen in cervical mucus, in contrast to the sperm quality in the ejaculate. In vitro Sperm-Mucus tests may be done using Kurzrok or Kremer technique with human or bovine mucus as well as with synthetic media. These in vitro tests do allow a good evaluation of sperm quality but only partially correlate with natural PCT. In an IVF group the PCT correlates with IVF fertilization and pregnancy outcome. It helps detecting the high risk group in which additional tests, antisperm antibody detection, acrosome reaction test, hamster test (SPA), hemizona assay (HZA), are recommended. These tests may sort those couples requiring sperm egg micro-injection. However, the PCT has been criticized for its poor methodology and mainly for its weak validity. In this IVF group, we performed a validity analysis of PCT and all sperm tests against fertilization and pregnancy rate. It confirms the weak validity indices of PCT and of all sperm tests as well. Nevertheless, in the stepwise regression analysis of all these tests against IVF fertilization and pregnancy, F-test value of PCT was almost similar to SPA/HZA and higher than sperm morphology. Thus, PCT is important and the weak validity indices of all sperm tests are probably due to the multifactorial nature of sperm quality. So, no single test may reliably check sperm fertilization potential. Male work-up does require a cascade of examinations including PCT to allow reliable evaluation and rational therapeutic act.

References

  1. ANSARI AH GOULD KG ANSARI VM. Sodium bicarbonate douching for improvement of the postcoital test. Fertil Steril, 1980; 33(6): 608–12

    PubMed  CAS  Google Scholar 

  2. BALASCH J, JOVE I, BALLESCA JL, MORENO V, MULET J, FUSTER J, VANRELL JA. Human in vitro fertilization in couples with unexplained infertility and a poor postcoital test. Gynecol Endocrinol, 1989;3(4): 289–95.

    Article  PubMed  CAS  Google Scholar 

  3. BOIVIN J, TAKEFMAN JE, BRENDER W, TULANDI T. The effects of female sexual response in coitus on early reproductive processes. J Behav Med, 1992; 15: 509–18

    Article  PubMed  CAS  Google Scholar 

  4. BRONSON RA, COOPER GW, ROSENFELD DL: Autoimmunity to spermatozoa: Effect on sperm penetration of cervical mucus as relfected by postcoital testing. Fertil Steril 41:4, 1984.

    Google Scholar 

  5. DAVAJAN V, NAKAMURA RM, KHARMA K: Spermatozoan transport in cervical mucus. Obstet Gynecol Surg 25:1, 1970.

    Article  Google Scholar 

  6. DAVAJAN V: POSTCOITAL TESTING. IN MITCHELL DR JR. DAVAJAN V. LOBO RA: Infertility, Contraception and Reproductive Endocrinolgoy. 3rd ed. pp 599–61 I. Oxford. Blackwell scientific Publications. 1991

    Google Scholar 

  7. DE AGOSTINI A, TUPAWFIK E, CAMPANA A. Quantitative post-coital test: sperm counts in cervical mucus after enzymatic liquefaction. Hum Reprod, 1996; 11(2):311–7.

    PubMed  Google Scholar 

  8. DOEHR SA, MOGHISSI KS: The mucin of human and bovine cervical mucus. In: Blandau RJ, Moshissi KS (eds): The Biolgoy of the Cervix, p 125. Chicago, University of Chicago Press. 1973.

    Google Scholar 

  9. DOODY MC, GOOD MC. The postcoital test: a quantitative method. J Androl, 1993; 14(2): 149–54

    PubMed  CAS  Google Scholar 

  10. EGGERT-KRUSE W, KOHLER A, ROHR G; RUNNEBAUM B. The pH as an important determinant of sperm-mucus interaction (avec commentaires. Fertil Steril, 1993; 60(3):588–90) Fertil Steril, 1993; 59(3): 617–28

    Google Scholar 

  11. EIMERS JM; TE VELDE ER; GERRITSE R; VOGELZANG ET; LOOMAN CW; HABBEMA JD. The prediction of the chance to conceive in subfertile couples. Fertil Steril 1994 Jan; 61(1):44–52

    PubMed  CAS  Google Scholar 

  12. EIMERS JM, TEVELDE ER, GERRITSE R, VANKOOY RJ, KREMER J, HABBEMA JD: The validity of the postcoital test for estimating the probability of conceiving. Am J Obstet Gynecol, 1994; 171(1): 65–70

    PubMed  CAS  Google Scholar 

  13. EIMERS JM; OMTZIGT AM; VOGELZANG ET; VAN OMMEN R; HABBEMA JD; TE VELDE ER: Physical complaints and emotional stress related to routine diagnostic procedures of the fertility investigation. J Psychosom Obstet Gynaecol, 1997; 18(1): 31–5

    Article  PubMed  CAS  Google Scholar 

  14. EVERHARDT E, DONY JM, JANSEN H, LEMMENS WA, DOESBURG WH. Improvement of cervical mucus viscoelasticity and sperm penetration with sodium bicarbonate douching. Hum Repord, 1990; 5(2):133–7.

    CAS  Google Scholar 

  15. FRIBERG J. Postcoital tests and sperm-agglutinating antibodies in men. Am J Obstet Gynecol, 1981; 141(1): 76–80

    PubMed  CAS  Google Scholar 

  16. GAMZU R, YOGEV L, AMIT A, LESSING J, HOMONNAI ZT, YAVETZ H. The hemizona assay is of good prognostic value for the ability of sperm to fertilize oocytes in vitro. Fertil Steril, 1994; 62(5): 1056–9

    PubMed  CAS  Google Scholar 

  17. GLATSTEIN IZ, BEST CL, PALUMBO A, SLEEPER LA, FRIEDMAN AJ, HORNSTEIN MD. GLATSTEIN. The reproductibility of the postcoital test: a prospective study. Obstet Gynecol, 1995; 85(3): 396–400

    Article  PubMed  CAS  Google Scholar 

  18. GLAZENER CM, KELLY NJ, WEIR MJ, DAVID JS, CORNES JS, HULL MG. The diagnosis of male infertility — prospective time-specific study of conception rates related to seminal analysis and post-coital sperm — mucus penetration and survival in otherwise unexplained infertility. Human Reprod, 1987; 2(8): 665–71

    CAS  Google Scholar 

  19. GRIFFITH CS, GRIMES DA: The validity of the postcoital test. [Avec commentaires, Am J Obstet Gynecol, 1991; 164(3):932–3] Am J Obstet Gynecol, 1990; 162(3): 615–20.

    Google Scholar 

  20. GRIMES DA. Validity of the postoital test [letter comment] Am J Obstet Gynecol, 1995; 172(4): 1327

    Article  PubMed  CAS  Google Scholar 

  21. HAFEZ ESE. Functional anatomy of the uterine cervix. In Infertility Male and Female. Insler V & Lunenfeld B Eds. 2nd Ed., Churchil & Livingstone Publ Edinburgh, London, 1993

    Google Scholar 

  22. HAMILTON CJ, EVERS JL, DE HAAN J. Ultrasound increases the prognostic value of the postcoital test. Gynecol Obstet Invest, 1986; 21(2): 80–8

    Article  PubMed  CAS  Google Scholar 

  23. HAYES MF, SEGAL S, MOGHISSI KS, MAGYAR DM, AGRONOW S. Comparison of the in vitro sperm penetration test using human cervical mucus and bovine estrus cervical mucus with the postcoital test. Int J Fertil, 1984, 29(3): 133–5

    PubMed  CAS  Google Scholar 

  24. HUHNER M. Sterility in the male and female and its treatment. Robman Publ, New York 1913

    Google Scholar 

  25. Hull MGR, Savage PE, Bromham DR. Prognostic value of the postcoital test: prospective study based on time-specific conception rates. Br J Obstet Gynaecol 1982;89:299–305.

    PubMed  CAS  Google Scholar 

  26. IISLER V, MELMED H, EICHENBRENNER I, SERR DM, LUNENFELD B. The cervical score. A simple semi-quantitative method for monitoring of the menstrual cycle. Int J Gynecol Obstet, 1972; 10: 223–8

    Google Scholar 

  27. INSLER V, GLEZERMAN M, BERNSTEIN D, ZEIDEL L, MISGAV N. Cervical crypts and their role in storing spermatozoa. In Advances and Diagnosis and Treatment of Infertility. Elsevier/North Holland, Publ, Amsterdam, 1981 p 195–211

    Google Scholar 

  28. JAGER S, KREMER J, KUIKEN J et al: Induction of the shaking phenomenon by pretreatment of spermatozoa with sera containing antisperma antibodies. Fertil Steril 36:784, 1984

    Google Scholar 

  29. KREMER J. A simple sperm penetration test. Int J Fertil, 1965; 10: 209

    PubMed  CAS  Google Scholar 

  30. The in vitro spermatozoal penetration test infertility investigation Thesis, Univerwity of Groningen Ed. Drukkerij Van Denderen NV publ. Groningen 1968

  31. KREMER J, JAGER S. The sperm-cervical mucus contact test: a preliminary report. Fertil Steril, 1976; 27(3): 335–40

    PubMed  CAS  Google Scholar 

  32. KREMER J; JAGER S; KUIKEN J. Treatment of infertility caused by antisperm antibodies. Int J Fertil, 1978, 23:4, 270–6

    PubMed  CAS  Google Scholar 

  33. KREMER J; JAGER S, VAN SLOCHTEREN-DRAAISMA T. The «unexplained» poor postcoital test. Int J Fertil, 1978, 23:4, 277–81

    PubMed  CAS  Google Scholar 

  34. KURZROK R, MILLER EG, Biochemical studies of human semen and its relationship to mucus of the cervix uteri. Am J Obstet Gynecol, 1928; 15: 56

    Google Scholar 

  35. LUNENFELD B, INSLER V: Infertility, pp 90–104. Berlin. Springer-Verlag. 1978

    Google Scholar 

  36. MATSON PL, TUVIK AI, O’HALLORAN F, YOVICH JL. The value of the postcoital test in predicting the fertilization of human oocytes. J In Vitro Fert Embryo Transf, 1986;3(2): 110–3

    Article  PubMed  CAS  Google Scholar 

  37. MOESLEIN S, TAUBERT HD. A comparison of the bovine cervical mucus penetration test and the postcoital test. Andrologia, 1987; 19(5): 528–31

    Article  PubMed  CAS  Google Scholar 

  38. MOGHISSI KS, SYNER FN, EVANS T, A composite picture of the menstrual cycle. Am J Obstet Gynecol, 1972; 114: 405–18

    PubMed  CAS  Google Scholar 

  39. MOGHISSI KS, Diagnosis and classification of disturbed sperm-cervical mucus interaction. In «Infertility Male and Female» Insler V & Lunenfeld B Eds, 2nd Ed., Churchil & Livingstone Publ Edinburgh, London, 1993. pp. 335–51

    Google Scholar 

  40. MORTIMER D, MORTIMER ST, SHU MA, SWART R. A simplified approach to sperm-cervical mucus interaction testing using a hyaluronate migration test. Hum Reprod, 1990; 5(7): 835–41

    PubMed  CAS  Google Scholar 

  41. ODERLAD E. Physical properties of cervical mucus. Adv Exp Med Biol 1997; 89:215.

    Google Scholar 

  42. ODEBLAD E, RUDOLFSON C. Types of cervical secretions: biophysical characteristics. In «The biology of the cervix» Blabdau RJ, Moghissi KS Eds, p. 267, University od Chicago Press, Chicago, 1973

    Google Scholar 

  43. OEI SG, HELMERHORST FM, KEIRSE MJ. When is the post-coital test normal? A critical appraisal. Human Reprod, 1995; lO(7): 1711–4

    Google Scholar 

  44. OEI SG, KEIRSE MJ, BLOEMENKAMP KW, HELMERHORST FM. European post-coital tests: opinions and practice. Brit J Obstet Gynecol, 1995; 102: 621–4

    CAS  Google Scholar 

  45. OEI SG, HELMERHORST FM, BLOEMENKAMP KW, KEIRSE MJ. Effect of the postcoital test on the sexual relationship of infertile couples: a randomized controlled trial. Fertil Steril, 1996; 65(4): 771–5

    PubMed  CAS  Google Scholar 

  46. OEI SG, BLOEMENKAMP KW, HELMERHORST FM, NAAKTGEBOREN N, KEIRSE MJ. Evaluation of the postcoital test for assessment of cervical factor infertility. Eur J Obstet Gynecol Reprod Biol, 1996; 64: 217–20

    Article  PubMed  CAS  Google Scholar 

  47. ROUMEN FJ, DOESBURG WH, ROLLAND R. Treatment of infertile women with a deficient postcoital test with two antiestrogens: clomiphene and tamoxifen. Fertil Steril, 1984;41(2): 237–43

    PubMed  CAS  Google Scholar 

  48. SHARARA FI; BEATSE SN; BAILEY SA; NEAL GS; CODDINGTON CC 3RD; SCOTT RT JR Characterization of Tru-Trax in-vitro penetration testing of cervical mucus. Hum Reprod, 1994;9(11): 2027–31

    PubMed  CAS  Google Scholar 

  49. SIMS J.M. Illustrations on the value of the microscope in the treatment of the sterile conditions. Brit Med J, 1866; 11:465–6.

    Google Scholar 

  50. SOFFER Y, MARCUS ZH, BUKOVSKI I, CASPI E. Immunological factors and post-coital test in unexplained infertility. Int J Fertil, 1976; 21: 89–95.

    Google Scholar 

  51. SOFFER Y, GOLAN A, HERMAN A, PANSKI M, CASPI E, RON-EL R. Prediction ofin vitro fertilization (IVF) outcome by the sperm penetration assay (SPA) with TEST Yolk buffer preincubation. Fertil Steril, 1992; 58(3): 556–62

    PubMed  CAS  Google Scholar 

  52. SOULES MR, MOORE DE, SPADONI LR, STENCHEVER MA. The relationship between the postcoital test and the sperm penetration assay. Fertil Steril, 1982; 38(3): 384–7

    PubMed  CAS  Google Scholar 

  53. TREDWAY DR, BUCHANAN GS, DRAKE TS: Comparison of the fractional postcoital test and semen analysis. Am J Obstet Gynecol 130:647. 1978

    PubMed  CAS  Google Scholar 

  54. TREDWAY D.R. The Postcoital Test. In Gynecology and Obstetrics, Sciarra J.R. Ed. Volume 5, Part 12-Infertility, Chap 51, Lippincott-Raven Publ. Philadelphia, New-York, Revised Edition, 1997

    Google Scholar 

  55. ULSTEIN M. Fertility of donors at heterologous insemination. Acta obstet Gynaecol Scand, 1973; 52: 97–101

    Article  CAS  Google Scholar 

  56. VIERGIVER E, POMMERENKE WT. Measurement of the cyclic variations in the quantity of cervical mucus and its correlation with basal temperature. Am J Obstet Gynecol, 1944; 48: 321

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre d’infertilité masculine, Université de Tel Aviv, Centre Médical Assaf Harofé, Zerifin, Israël

    Y. Soffer & S. Kaufman

  2. Unité d’infertilité et de FIV, Service d’obstétrique, Université de Tel Aviv, Centre Médical Assaf Harofé, Zerifin, Israël

    A. Raziel, S. Friedler, D. Strassburger & R. Ron-El

  3. Service de gynécologie Faculté de Médecine Sackler, Université de Tel Aviv, Centre Médical Assaf Harofé, Zerifin, Israël

    A. Herman

Authors
  1. Y. Soffer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Raziel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Friedler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Kaufman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Strassburger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Herman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Ron-El
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Soffer, Y., Raziel, A., Friedler, S. et al. Place des tests d’interaction sperme-mucus dans le bilan masculin de l’infécondité. Androl. 8, 36–46 (1998). https://doi.org/10.1007/BF03034760

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03034760

Mots-clés

Key-words

Basic and Clinical Andrology

ISSN: 2051-4190