Sperm transport in the human female genital tract and its modulation by oxytocin as assessed by hysterosalpingoscintigraphy, hysterotonography, electrohysterography and Doppler sonography

Abstract

The transport function of the uterus and oviducts and its modulation by oxytocin has been examined using hysterosalpingoscintigraphy, recording of intrauterine pressure, electrohysterography and Doppler sonography of the Fallopian tubes. After application to the posterior vaginal fornix, a rapid (within minutes) uptake of the labelled particles into the uterus was observed during the follicular and during the luteal phase of the cycle in all patients. Transport into the oviducts, however, could only be demonstrated during the follicular phase. Transport was directed predominantly into the tube ipsilateral to the ovary bearing the dominant follicle; the contralateral oviduct appeared to be functionally closed. The proportion of patients exhibiting ipsilateral transport did increase concomitant with the increase of the diameter of the dominant follicle. That ipsilateral transport has biological significance is suggested by the observation that the pregnancy rate following spontaneous intercourse or insemination was significantly higher in those women in whom ipsilateral transport could be demonstrated than in those who failed to exhibit lateralization. Oxytocin administration was followed by a dramatic increase in the amount of material transported to the ipsilateral tube, as demonstrated by radionuclide imaging and by Doppler sonography following instillation of ultrasound contrast medium. Continuous recording of intrauterine pressure before and after oxytocin administration did show an increase in basal tonus and amplitude of contractions and a reversal of the pressure gradient from a fundo-cervical to a cervico-fundal direction. These actions of oxytocin were accompanied by an increase in amplitude of potentials recorded by electrohysterography. These data support the view that uterus and Fallopian tubes represent a functional unit that is acting as a peristaltic pump and that the increasing activity of this pump during the follicular phase of the menstrual cycle is reflected by an increased transport into the oviduct ipsilateral to the ovary bearing the dominant follicle. In addition, they strongly suggest a critical role of oxytocin in this process. Failure of this mechanism appears to be a cause of subfertility or infertility, as indicated by the low pregnancy rate following intrauterine insemination or normal intercourse in the presence of patent Fallopian tubes. It may be regarded as a new nosological entity for which we propose the term tubal transport disorder (TTD). Since pregnancy rate of such patients is normal when treated with in-vitro fertilization (IVF), hysterosalpingoscintigraphy seems to be useful for the choice of treatment modalities in patients with patent Fallopian tubes suffering from infertility.

Current scientific and practical luteal phase support strategies

“…Возможны четыре механизма «первичного прохож-дения прогестерона в матку» при интравагинальном использовании микронизированного прогестерона: 1) прямая диффузия через ткани [31]; 2) пассаж прогестерона через цервикальный ка-нал из влагалища в полость матки [32];…”

Baby got Back: Some Brief Observations on Obesity in Ancient Female Figurines: Limited Support for Waist to Hip Ratio Constant as a Signal of Fertility

“…There is indirect evidence for a link between female orgasm and fertility (9,10,11,12). However, to date, the evidence is mixed and hotly disputed (13).…”

The Evolution of Female Orgasm: Adaptation or Byproduct?

“…Female orgasm also causes patterns of brain activation and hormone release associated with increased uterine contractions, lower uterine pressure, and movement of semen into the uterus. Peristaltic uterine contractions transport sperm in rats, dogs, cows (Singer, 1973) and probably humans (Wildt et al, 1998) and appear to be caused both by a hormone released during orgasm and by stimulation of brain areas activated during orgasm. In women, orgasm activates the cingulate cortex and medial amygdala (Komisaruk et al, 2004), and electrical stimulation of these areas in experimental animals induces uterine contractions (Beyer et al, 1961;Setekleiv, 1964).…”

“…Orgasm also activates the paraventricular nucleus (PVN; Komisaruk et al, 2004), and both PVN stimulation (Cross & Wakerley, 1977) and orgasm have been found to cause oxytocin release into the bloodstream (Blaicher et al, 1999;Carmichael et al, 1987;Carmichael et al, 1994). Oxytocin, in turn, induces uterine contractions (Knaus, 1950;Wildt et al, 1998), changes uterine pressure from outward to inward, and increases the transport of a semen-like fluid into the uterus and oviducts (Wildt et al, 1998).…”