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Clinic of Gyneacology and
Obstetrics “Narodni Front”
Clinical Center of Serbia
“OPTIX” - Belgrade
DETERMINATION OF
FERTILE AND INFERTILE DAYS OF THE
MENSTRUAL CYCLE OF WOMEN
BY USING THE SALIVA CRYSTALLIZATION TEST
( “LADY TEST” - “GANOP TEST” )
Ratomir Ganovic, MD, Ph.D., Assistant
Professor
Mladenko Vasiljevic, MD, Ph.D., Instructor
Nikola Bogunovic, MD
Radisa Devic, B. Eng.
Dragomir Stamenkovic , B. Eng.
Belgrade, September 1994
Introduction
In health
institutions, there are numerous
possibilities for determination of fertile
and infertile days of the menstrual cycle of
women. All those methods are ovulation
based (Pschyrembel W. 1977). We shall
enumerate only some of the methods :
measurement of basal temperature, vaginal
cytology, cervical changes (external uterine
orifice dilatation, the quantity of mucus,
distensible quality, crystallization, cell
contents), endometrial biopsy, determination
of hormones in blood and urine, sonography
(development of the follicle and endometrial
changes). None of the methods is
absolutely reliable in confirming the
ovulation. They are based on changes in
levels of ovarian hormones, estrogen and
progesterone, occurring in the course of the
menstrual cycle.
The only direct
and absolutely positive methods indicating
the existence of ovulation are the
pregnancy incepted in the observed cycle
or finding of the ovum in genital organs.
All those methods
require every day visits to a specialist -
gyneacologist in a health institution. The
only way a woman can determine the time of
ovulation without consulting the doctor is
by measuring basal body temperature. Rising
of temperature by about 0.5 to 0.6 C0 results
from progesterone effects on
thermoregulatory center in hypothalamus.
Such a rise in basal temperature occurs in
case of ovulation with appearance of corpus
luteum and progesterone generation (Mladenovic
D. 1973). However, the precise day of
ovulation cannot be determined in advance by
the measurement of basal temperature. The
rise in basal temperature occurs only 1-2
days after ovulation so that, as a result,
the existence or non-existence of ovulation
may be determined only afterwards by using
temperature tables. (Speroff L.,Glass R.H.,
Kase N.G. 1976).
Determination of
fertile days in clinical practice is most
frequently done by FERN-TEST - the test of
the cervical secretion crystallization.
Papanicolaou (Papanicolaou G.N., 1942) was
the first who observed that the vaginal
mucus during ovulation, smeared and dried on
glass slide, manifests crystallization in
the fern -like form. This phenomenon is most
evident in the periovulatory period, 3-4
days before the occurrence of ovulation.
Crystallization
results from biophysical and biochemical
changes in cervical mucus under the
influence of ovary hormones (Abarbanel
H.R.,1946).
Secretion
activity of the cervical epithelium during
the menstrual cycle is effected by ovary
hormones. The cervix is under the influence
of estrogen in the course of the whole
menstrual cycle. This influence is the
strongest 3 - 4 days before the ovulation
when the secretion of estrogen reaches the
highest level in the course of the cycle and
has a strong effect on cervical epithelium.
As a result of different levels and ratios
of estrogen and progesterone, cyclical
variations appear in the quantity of
cervical mucus and certain inorganic salts (Hagenfeldt
K.,1972).
Mac Donald and
Roland (Mac Donald R.R.,1969; Roland
N.,1958) consider sodium the main component
of electrolytes of cervical mucus and along
with calcium ions brings
about the phenomenon of crystallization,
known as FERN mucus reaction. According
to Toyoshima (Toyoshima K.,1956), sodium
chloride accounts for 90% of all inorganic
salts in cervical mucus related to
ramification.
Cervical mucus
crystallization - FERN TEST - the test of
branching, is tested every day in the
periovulatory period of the cycle in the
following way: First, the external uterus
orifice is wiped by gauze and then a stick
covered with cotton wool is inserted into
the cervical canal up to internal cervical
orifice. Cervical mucus is taken by a
circular movement and then smeared on a
glass slide. After drying for 10-15 minutes
at the room temperature, the plates are
examined under a microscope.
On the 10th and
11th days , as a result of weak estrogen
activity, there is only partial
crystallization of NaCl with occasional
tiny fern branches - like “frost on the
window”. Such findings are registered as
mildly evident positive FERN test and are
marked by (+). On 12th and 13th days , as a
result of increased estrogen activity, the
crystallization appears in the form of
tender fern branches that occupy only a
portion of the microscope field . Such a
positive FERN test is marked by (++). On
14th and 15th days, at the time of maximum
estrogen activity , crystallization appears
in the form of rough and thick fern or palm
leaves that occupy the whole microscope
field. Such findings are marked by (+++).
Due to changes
in the uterine cervix, the examination of
the uterine cervix secretion is sometimes
made difficult. Excessive secretion of the
uterine cervix glands or the abundant
presence of leukocytes and other cells, can
alter the crystallization of the secretion
, which is called “dysmucorrhea”. In
certain cases, examination is made difficult
or impossible due to bleeding of the
cervix in contact with the stick.
Determination of
the ovulation by means of the FERN test
requires every day visit to a gynaecologist.
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