Improvement of Cervical Factor with Guaifenesin

by Jerome H. Check,M.D., H.G Adleson, B.S.,
Chung-Hsis Wu, M.D.

Guaifenesin is an exportant capable of increasing respiratory tract fluid. It is a common ingredient of many antitussive preparations. A study was designed to see whether this agent could also improve cervical mucus, as manifested by improved sperm survival and fertility.

Materials and Methods
Forty couples with a minumum of 10 months of infertility were selected where there was no sperm motility on postcoital testing. Hostile cervical mucus rather than defective spermatogenesis was assumed on the basis of accepting in the study only those couples where the baseline spermogram after 48 hours abstinence had at least a count of 25 x 10 6/cc, a 2-cc volume, 70% motility, grade 3 of 4 quality, and less than 20% abnormal forms.

The postcoital test was performed on the 2nd day before the temperature rise. Two baseline postcoital tests with no sperm motility 2 hours after intercourse were required before the couple was entered in the study. After wiping off the cervix with cotton, the mucus was aspirated with a tuberculin syringe. If the mucus quality (spinn-barkeit, ferning, lack of cellularity) was good but with no sperm motility, the couple was not included in the study. Similarly, if cervical mucus was absent, the couple was not accepted for the study.

Ovulation was established on the basis of a serum progesterone level x2 over 10/ng/ml taken 1 week before menses and a biphasic basal body temperature chart with a minimum of a 13-day luteal phase. IF drug therapy was required to establish ovulation, the couple could be selected as long as the drug required was not clomiphene citrate and/or human menopausal gonadotropins.

Each woman was treated with 200mg guaifenesin orally three times daily from day 5 to her temperature rise in either the commonly available antitussive elixir form or in capsule form.

Response to guaifenesin as reflected by postcoital evaluation was scored as "no improvement" (no motile sperm), "marked improvement" (at least 3 to 5 sperm per high-powered field with good linear progressive motion), or "slight improvement" (some motile sperm but a number or quality of motility inferior to standards set for the "marked improvement" category). Mucus quality was juddered before and after guaifenesin as to spinnbarkeit and cellularity. If the patient showed some improvement in the postcoital test, then the therapy was continued for a minimum of 6 months unless conception occurred first. If there still was no sperm survival after two treatment cycles, the therapy was considered a failure and was stopped. Though the patient would then be treated with other methods, as far as this study was concerned she would only be listed in the "no improvement" category. No patient in the study was allowed to have treatment with any other therapy that could positively or negatively influence the cervical mucus.

The tubal factor was investigated by either hysterosalpingogram or laparoscopy. Seventy percent of the patients had a laparoscopy.

	Total	Marked Improvement	Slight Improvement	No Improvement
Number of patients in Subgroup	40	23 (57.5%)	7 (17.5%)	10 (25%)
I	10	8	1	1
II	30	15	6	9
Number pregnant
I	8	7	1	0
II	8	8	0	0
% pregnant
I	80	87.5	100	0
II	26.6	53	0	0
Total	40	65.2	14.3	0

Results

The response to guafenesin is seen in Table 1. Twenty-three of 40 patients showed marked improvement in postcoital following treatment, while 7 showed slight improvement was associated with improvement in the mucus quality (improved spinnbarkeit and decreased cellularity).

Fifteen pregnancies in 23 couples (65.2%) occurred in the group showing marked improvement in the postcoital tests after guafenesin therapy. One patient with only a mild improvement in sperm survival achieved a pregnancy. In ten patients with hostile mucus as the only detectable cause of the infertility, eight became pregnant in an average 2.4 months. In the remaining eight patients achieving pregnancies, where other fertility problems coexisted, there was an average of 5.6 months of treatments with guaifenesin. One patient, despite a marked improvement in sperm survival and no other apparent cause for infertility, did not achieve a pregnancy after 6 months of guaifenesin therapy. Only one of seven patients showing a slight improvement in sperm survival achieved pregnancy. The failure of eight patients to achieve pregnancies despite marked improvement in sperm survival can BA accounted for by other associated fertility problems.

Discussion

The results indicate that guafenesin may improve cervical mucus and improve fertility. A double-blind study was not deemed necessary, since it was easy to follow the objective parameter of sperm survival and correlate this with subsequent fertility. There is no evidence that psychological factors can adversely affect cervical mucus in the presence of ovulation. The exact mechanism of action of guafenesin is not known, though it would seem to be reasonably similar to its mechanism of improving respiratory tract secretions. Other methods of treating the cervical factor have been reviewed by Blasco. An additional technique employing high-dose estrogen in combination with human menopausal gonadotropins has been described more recently. The quoted pregnancy statistic following conventional therapy of the cervical factor has been under 30%. With guafenesin therapy 40% of the entire cervical factor group conceived. In the subgroup of patients whose fertility problem seemed likely to be related to the cervical factor only, 80% conceived. These statistics will probably improve when guaifenesin therapy is combined with other treatment modalities for the cervical factor.

Fertility and Sterility
May 1982