Cervical Mucus: A Marker for Ovulation, A Must for Pregnancy?
For many of us, there is nothing more off-putting than the thought of tracking our cervical mucus day after day, month after month. It’s not easy to figure out what you are looking at, why you are staring at your underwear, how long this exercise needs to go on, and what you will do with this information.
Egg white versus watery, creamy versus sticky. Are we baking a cake or making a baby? While in many ways, it’s sort of a little bit of both, tracking your cervical mucus is not a prerequisite for detecting ovulation or having a baby. The changes that occur over the course of your monthly cycle can provide helpful hints on both if and when you are ovulating. However, while it is important and does serve as an indicator of impending ovulation and a reservoir for sperm, it is much lower on the fertility pecking order in terms of importance.
The cervix is the lower part of the uterus (a.k.a. the womb); it is the conduit between the uterus and the vagina. When not pregnant, the cervix measures about 2 to 3 cm. During pregnancy and particularly as its end is near, the cervix begins to shorten, thin out, and ultimately dilate. Think of the cervical mucus as the pond at the base of this conduit. It serves as a reservoir for sperm by providing it with nutrients and safety for several days (up to five, to be exact!). While the majority of sperm is in the tubes minutes after ejaculation, the pond holds on to the stragglers. Over the course of about three to five days, live sperm are released into the uterus and the tubes, hoping to meet a mate and make an embryo.
Much like the variability in the uterine lining during the approximately one-month-long menstrual cycle, the cervix and its mucus also go through a host of changes. After bleeding has stopped, the cervical mucus is usually scant, cloudy, and sticky. This lasts for about 3–5 days. What comes next is the stuff that you are taught to look for. In the three to four days leading up to and after ovulation, the mucus changes to clear, stretchy, and fairly abundant. Following ovulation, the cervix becomes somewhat quiet, and cervical discharge remains scant and creamy like lotion. The “stage hands” behind the curtain setting the scene for the changes observed in cervical mucus are estrogen and progesterone production. Altering levels of estrogen and progesterone results in major modifications in mucus content and production.
If the cervix falls short on producing and maintaining its reservoir (a.k.a. mucus), problems can arise. However, while cervical factor infertility used to be considered a serious and real problem, today with more advanced testing, the cervix and cervical mucus production are hardly ever the cause of infertility (only about 3% of infertility cases are actually due to the cervix). Because of this, tests to evaluate the cervix/mucus are no longer needed.
Traditionally, a postcoital test (nicknamed the PCT) was performed to seek out cervical dysfunction. Now, picture this: fertility doctors used to obtain a sample of cervical mucus before ovulation and after intercourse and check it out under the microscope. They were looking for the presence (or absence) of moving sperm. Although this is sometimes used in couples that cannot have a formal sperm check, it is otherwise one for the ages. The subjectivity, poor reproducibility, and very inconvenient aspect of it have eighty-sixed the PCT in the land of fertility medicine.
In cases where the cervix has been previously cut, burned, or frozen, a narrowing of the cervical canal can arise (medically called cervical stenosis). Cervical stenosis can make procedures that require access to the uterus difficult (picture trying to pass something through a really narrow hole—it doesn’t fit!). Therefore, prior to undergoing any fertility treatment, a cervical dilation (that is, a widening of the cervix) may be required. This allows your doctor to then put sperm or embryos back inside the uterus.
However, while the narrowing can make infertility procedures somewhat more challenging, the width is not what’s causing the entire problem. Cervices that have been exposed to trauma like surgery can have difficulty producing mucus. No mucus equals not much of a place for the sperm to gain entry to the uterus or hang out (cue IUI or IVF).
While the cervix may not be playing the feature role in the fertility play, it does serve as an important role. In addition to providing a respite to sperm, it also helps maintain a pregnancy to term. When a cervix shortens or dilates before time’s up, it can lead to a snowball of negative events: preterm labor and preterm delivery, to name a few. Bottom line, it’s not only a reservoir but also a roadblock. Until that nine-month mark has passed, it should not let anything out that front door!
In Eastern medicine, we track the changes in cervical mucus as both a way to detect impending ovulation and as a gauge on hormone production. Obviously, we love combining Eastern and Western medicine, especially for testing, but if a patient is not yet under the care of a Reproductive Endocrinologist or a GYN willing to test hormones, the cervical mucus quality can give us quite a bit of info. Just prior to ovulation, Estrogen is at it’s high point, which stimulates the cervix to produce that watery, stretchy discharge. After ovulation, in the presence of rising Progesterone, the discharge becomes more opaque, white and creamy. Because acupuncture and some herbs/supplements can enhance ovarian function and therefore hormone production, when a patient reports increases in these two types of discharge, we know we are on the right track. However, we’ve seen plenty of Women conceive without abundance of this stuff, so don’t get frustrated if it’s not obvious for you!
Track your cervical mucus if it feels helpful for you, but don’t drive yourself nuts. Yes its presence is a good sign for fertility and it can be a way to loosely gauge hormones and ovulation but it’s not the only way, nor is it the most accurate. While we are advocates of knowing your body and being aware of what’s going on with your cycle, we’ve seen too many women get anxious about their cervical mucus who did not have an issue. With the combination of Eastern and Western medicine, we have ways to optimize the hormones and cervical mucus production and if that doesn’t help, intrauterine insemination (IUI) and in vitro fertilization (IVF) are ways to get the sperm to meet the egg even if the cervix isn’t cooperating!