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NO Cervical Mucus?
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PiggieFarmer posted:
Hello everyone,

My husband and I have been TTC for about 24 cycles with no luck.

One thing I am supposed to look for is cervical mucus, and I have NONE. Not egg-white, not "hostile"... nothing. I know what I am looking for based on photos, and I do not recall seeing it for at least the past 10 years. My vagina is moist all the time, basically like the inside of my mouth, but I am never (ever) wet on the outside.

I am pretty sure I should be concerned, though two doctors I visited don't seem concerned. What can be causing this, and what should I do about it?

I have already tried drinking more water and using guaifenesin, and have not seen any difference. That is supposed to *thin out* mucus to make it egg-white, but the problem here is that I am producing none to begin with. We have also tried using Preseed, but my understanding is that it can't substitute for cervical mucus.

Here is my other background:

I am 37 and he is 35. We are using the Clearblue monitor, and ovulation seems normal based on that (no temp charting, just the monitor). I have had estrogen and progesterone checked, and again normal. Cycles are are almost always 27 days long, with ovulation on day 12 or 13.

I am taking several prescription medications: Lexapro and Ritalin, and I recently stopped taking Buproprion. I have been taking prenatal vitamins and fish oil, as recommended by my GYN. I am thinking about taking FertileCM.

Thanks for any advice!
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DUKE MEDICINE
David K Walmer, MD, PhD responded:
The field of fertility is better at therapy than diagnosis & what we know about cervical mucous probably won't help you directly. The best way to evaluate cervical mucous is by taking the mucous directly out of the cervix with a 1 ml syringe around the time or just before your LH surge and analyzing the water content. The problem is that evaluating cervical mucous accurately requires laboratory equipment that most doctors don't have because we haven't been able to demonstrate that doing this identifies a treatable fertility problem in an individual couple. One way to treat this poor cervical mucous, if you are concerned, is to do a well timed intrauterine insemination based on an Ovidrel trigger (surrogate LH surge). This requires you to have periodic ultrasounds to determine the right time to administer the Ovidrel. Frequently we combine this with another ovulation induction medication like clomiphene citrate, tamoxifen or letrozole. It would probably be worthwhile evaluating other factors at the age of 37 as well as we know that there is a natural age-related decline in fertility that is related to egg quality. Good luck!
 
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PiggieFarmer replied to David K Walmer, MD, PhD's response:
Thanks for the reply! I found this to be an especially good way of describing our situation:
"The field of fertility is better at therapy than diagnosis"


There does indeed appear to be less interest in determining causes than trying out options. Unfortunately, we can't use IUI (or IVF) for religious reasons, and that's partly why we want to understand "why" and hopefully do something about it. The cervical mucus issue stands out as the only visible abnormal thing, and we have read in several places that CM is important.


We have not had the exact CM test you describe, but we did have a post-coital test. It indicated 1 of out 10 sperm active, which apparently is normal (also, his earlier sperm test was fine). I also had AMH checked about a year ago: it was 0.53 in the lab range of 0.16 - 8.43. That was regarded as low, but I am not clear on the significance.


Thanks for any other advice you might have.


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