Ganovic et al, Page 1 Introduction

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.