Assessment of Cervico-Vaginal Factors
The cervix is the canal that connects the vagina to the uterus. It measures approximately 3 cm and has important functions related to fertility:
• changing its consistency from thicker to thinner to allow the passage of sperm during ovulation;
• protecting the sperm from the acidic environment of the vagina;
• selecting the most mobile sperm for fertilization, leaving behind those with impaired motility;
• the sperm's capability: nourishment of sperm and separation of sperm components.
Any change in the cervix can lead to a fertility issue. However, only 5-10% of couples facing difficulties in conceiving have infertility caused by the cervical factor.
What are the causes?
Cervical problems that can lead to infertility can be differentiated into anatomical or functional. In both cases, the correct migration of sperm to the uterus and fallopian tubes is affected.
Anatomical causes include: developmental abnormalities, polyps, fibroids, cysts, cervicitis, cervical trauma
Functional causes refers to the modification of cervical mucus characteristics: quantity, consistency, acidity. Among these can be: insufficient estrogen release, the use of medications with antiestrogenic effects (clomiphene), infection of the cervical canal walls, formation of antisperm antibodies.
How do we diagnose?
The following tests are recommended for diagnosing the cervical factor of infertility:
• Postcoital test - studies the presence or absence of mobile sperm in cervical mucus after sexual intercourse.
• Microbiological cultures - to confirm if there is any bacterial infection.
• Cervical permeability test - a cannula is inserted to check if it passes easily or if there is any obstruction.
• In vitro immunologic test - it assesses the mucus-sperm interaction, along with the characteristics, the ability of sperm to pass through cervical mucus, and the presence of antisperm antibodies in both fluids.
• Cervicoscopy - the inside of the cervix is studied by inserting a camera.
Postcoital test
The postcoital test (PCT) is used to exclude the cervical factor of infertility by assessing the quality of cervical mucus and the survival of sperm after sexual intercourse before ovulation.
PCT involves the microscopic examination of a specimen of cervical mucus obtained before ovulation, from four to eight hours after sexual intercourse. The test is not painful. Results are released on the same day.
To obtain accurate results, it is important to observe the following conditions:
• The optimal period for performing the postcoital test is 24-48 hours before ovulation. Testing done well before or too late after ovulation is not considered valid.
• The partner should have normal sperm parameters.
• The postcoital test should be performed no later than 6 hours after sexual intercourse.
The test result will contain information about:
• Quantity and quality of cervical mucus
• Presence or absence of mobile sperm in cervical mucus
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Infertility
• Infertility in couples
• Recurrent miscarriages and halted pregnancies
• Uterine factor: thin endometrium, endometritis, adhesions, polyps, uterine fibroids, etc.
• Ovarian factor: low ovarian reserve, polycystic ovary syndrome, ovarian cysts
• Hereditary and acquired thrombophilia
• Gynecological infections: chlamydia, mycoplasma, ureaplasma
• Menstrual disorders: painful, heavy, irregular, amenorrhea
• Specialization in endocrinology
Fertilizare In Vitro
• Pregătirea cuplului către fertilizarea in vitro
• Folosirea adjuvantelor pentru sporirea succesului FIV: anticoagulante, imunoterapie, terapie hormonală pre-FIV, ”scratching” endometrial, PRP (Platelet-Rich Plasma), irigații intrauterine, vitamine, suplimente nutritive
• Alegerea protocolului de stimulare ovariană, Mini-FIV, FIV în ciclul natural
• Monitorizare ecografică și hormonală a stimulării ovariene
• Eșecuri repetate ale procedurii FIV
• FIV la femeile după 40 ani
• Referire pentru procedura FIV către clinicile partenere din RM, Ucraina, România, Europa
• Conduita sarcinii după FIV
• Treatment of genital tract infections (Chlamydia, Mycoplasma, Ureaplasma, Trichomonas, Candida, Gardnerella, etc.). This includes performing treatment procedures: uterine instillations, Vaginal PRP
• Couple's infertility: folliculometry, ovarian stimulation, intrauterine insemination, foam sonohysterography, hysteroscopy
• Reproductive rejuvenation: Vaginal PRP, Endometrial PRP
• Specialization in endocrinology
• Diagnosis and treatment of female infertility
• Treatment of endocrine-dependent menstrual cycle disorders (endometriosis, polycystic ovary syndrome, uterine fibroids)
• Pregnancy planning
• Hormone replacement therapy in menopause and post-menopause.