Peritoneal recovery of sperm in patients with infertility associated with inadequate cervical mucus

In an effort to complete an infertility evaluation in a group of 25 patients with unexplained infertility, except for persistent inadequate cervical mucus and poor-to-negative postcoital tests, laparoscopy was scheduled as close as possible to the ovulatory day of the cycle. Patients were artificially inseminated with their husbands' sperm 2 or 3 hours before laparoscopy. Sperm was recovered at the time of laparoscopy through a second probe from the pouch of Douglas before and after hydrotubation with a dilute solution of methylene blue. The results were compared with those obtained in a group of 15 women with unexplained infertility and normal cervical mucus and postcoital tests. Sperm were recovered from 8 of 15 control subjects (53.3%) and from 14 of 25 patients (56.1%). In most cases with positive results, sperm were found in the peritoneal cavity before hydrotubation. It is apparent that sperm can reach the peritoneal cavity regardless of the quality or quantity of cervical mucus. It also appears that a normal postcoital test may not indicate adequate sperm transport into the upper genital tract. These results confirm previous observations and question the usefulness of many in vitro tests presently in use for evaluation of sperm penetration in the female genital tract.