Objectives
To appraise the value of 'cervicosonography' in predicting occurrence of pregnanc. To display US appearance of the cervix during various phases of the ovarian cycle (sponatneous and induced)and relating this to follicular development, endometrial thickness and serum estradiol.
Methods
An observational cross-sectional study. This trial was conducted at the Department of Obstetrics and Gynecology, Women's Health Center, Assiut, between August 2008 and March 2010. Infertile women with documented normal semen analysis of husband, normal HSG presented for infertility outpatient clinic [hospital and private]. We included 59 patients who were followed up for 3 successive ovarian cycles for ovulation monitoring whether spontaneous or induced cycles using either CC or gonadotrophins and timed intercourse. A total of 136 cycles were documented and concluded as 'ovulatory'.
All patients had tansvaginal ultrasonography done 3-4 times per ovarian cycle; once day 5-8, once day 9-11, 12-15, once day 16-19 if required. The following parameters were recorded; follicular development, endometrial thickness, endocervical mucosal echogenicity, and endocervical mucus.
Primary outcome measures: thickening of the endocervix and appearance of cervical mucus; documented by TVS. Secondary outcome measures: occurrence of clinical pregnancy.
Results
Cervical mucus was seen when mean follicular diameter was 16.5mm and median endometrial thickness was 7.5mm. Both appearance of endocervical mucus and thickening of endocervical mucosa ≥ 4.65 mm were essential for the pregnancy to occur.
Conclusions
Cervix is a dynamic structure changing under the effect of ovarian hormones. Endocervical changes and appearance of cervical mucus is a good bioassay to the ovulatory state and may obviate the need for measurement of serum estradiol.