The pin-hole cervical os; a small fertility problem

Area of Science:

• Reproductive Medicine
• Gynecology
• Infertility Research

Background:

• A pin-hole cervical os is a rare condition observed during the pre-ovulatory phase of the menstrual cycle.
• This cervical anomaly is frequently associated with extreme oligomucorrhea and diminished cervical mucus quality, posing challenges for natural conception.

Purpose of the Study:

• To investigate the fertility prognosis of women diagnosed with a pin-hole cervical os during the pre-ovulatory phase.
• To evaluate the potential influence of in utero diethylstilbestrol (DES) exposure on fertility outcomes in these women.
• To explore the correlation between post-coital test (PCT) results and pregnancy achievement.

Main Methods:

• Study population comprised 850 infertile couples, identifying 24 women with a pin-hole cervical os.
• Sperm quality assessment excluded four couples due to poor sperm parameters.
• Pregnancy outcomes were analyzed based on coitus and intra-uterine artificial insemination (AIH), considering factors like DES exposure and PCT results.

Main Results:

• Overall pregnancy rates were low (2/24 by coitus, 0/24 by AIH).
• Nine women had a history of in utero diethylstilbestrol (DES) exposure, potentially impacting fertility prognosis.
• In women without DES exposure, a positive post-coital test (PCT) correlated with successful conception via coitus (4/8 pregnancies), while a poor PCT favored intra-uterine AIH (3/3 pregnancies).

Conclusions:

• In utero diethylstilbestrol (DES) exposure may negatively influence the fertility prognosis for women with a pin-hole cervical os.
• A pin-hole cervical os in the pre-ovulatory phase, in the absence of DES exposure, appears to have minimal impact on a woman's fertility.
• The post-coital test (PCT) is a valuable predictor of conception success, guiding the choice between natural conception and assisted reproductive technologies.