Effects of the levonorgestrel-releasing intrauterine system on cervical mucus quality and sperm penetrability☆
Abstract
Background
In levonorgestrel intrauterine system (LNG-IUS) users, the prevention of sperm penetration through cervical mucus has not been demonstrated.
Study Design
Subjects were enrolled in an investigator-blinded study to compare quality and sperm penetrability of mid-cycle cervical mucus between LNG-IUS users and hormone-free controls. Cervical mucus was microscopically examined using World Health Organization (WHO) cervical mucus analysis (CMA). CMA score ≥10 of 15 points indicated cervical mucus favoring sperm penetration. Mucus was incubated with sperm using the WHO simplified slide test (SST) and Kremer sperm cervical mucus penetration test (SCMPT).
Results
Data from 14 LNG-IUS users and 16 controls showed 14% of LNG-IUS users had CMA score ≥10% vs. 69% of controls (p=.004). SST showed no sperm penetration for LNG-IUS users, significantly less than controls (0% vs. 64.3%, p<.001). SCMPT demonstrated no sperm mucus penetration for LNG-IUS users at 2 and 6 h (0% vs. 85% in controls with 2-h score ≥6, p<.001; 6 h 0% vs. 79% in controls, p<.001).
Conclusions
Mid-cycle cervical mucus of LNG-IUS users is poor quality and prevents endocervical sperm transport in vitro.
Keywords: Contraceptive mechanism, Fertilization, Intrauterine device, Kremer Test, Sperm-cervical mucus Interaction
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☆ This study was presented orally as a Scientific Prize Paper Candidate and recipient of the Researcher In-Training Award at the 65th Annual Scientific Meeting of the American Society for Reproductive Medicine in Atlanta, GA, USA, on October 21, 2009. The study was funded through an educational grant from an anonymous donor. The sponsor had no role in study design, data collection, analysis or interpretation or report writing.
PII: S0010-7824(10)00359-8
doi:10.1016/j.contraception.2010.06.006
© 2010 Elsevier Inc. All rights reserved.
