Long‐term ongoing pregnancy rate and mode of conception after a positive and negative post‐coital test

Hessel, M.; Brandes, M.; Bruin, Jan Peter de; Bots, R.S.G.M.; Kremer, J.A.M.; Nelen, W.L.D.M.; Hamilton, C.J.C.M.

doi:10.1111/aogs.12442

Cited by 10 publications

(8 citation statements)

References 22 publications

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“…Glazener et al (2000) showed that the PCT is particularly predictive if the test is performed in couples with a relatively short duration of infertility, which usually is the case in couples who are referred to the gynaecologist for the first time and not in couples who are referred to a tertiary care centre. Hessel et al (2014) showed in a large cohort study that 3 years after the PCT is performed, a significant difference in overall pregnancy chance still remains between couples having a positive test and a negative test result, making the PCT a long-term predictor of pregnancy. For this reason, it is difficult to understand why the UK National Institute for Health and Care Excellence guideline states that the PCT has no predictive value on pregnancy rate.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, if the medical history is uneventful as far as sexually transmitted diseases, pelvic infections or surgery are concerned, the likelihood for tubal pathology is low, and thus no urgent need exists to test the patency of the tubes ( Coppus et al , 2007b ; Luttjeboer et al , 2009 ; NVOG, 2004 ; Verhoeve et al , 2011 ). Many doctors have abolished the postcoital test (PCT) in view of its presumed lack of predictive value ( Oei et al , 1998 ; NICE, 2013 ; NVOG, 2004 ) although this has been questioned by others ( Eimers et al , 1994 ; Hunault et al , 2004 ; van der Steeg et al , 2004 ; Hessel et al , 2014 ). Chlamydia serology has only limited prognostic value, and if a screening test for tubal pathology is necessary, the hysterosalpingography (HSG) is preferred ( ASRM, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

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A concise infertility work-up results in fewer pregnancies

Hamilton

Steeg

Hamilton

et al. 2021

Human Reproduction Open

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STUDY QUESTION Is pregnancy success rate after a concise infertility work-up the same as pregnancy success rate after the traditional extensive infertility work-up? SUMMARY ANSWER The ongoing pregnancy rate within a follow-up of 1 year after a concise infertility work-up is significantly lower than the pregnancy success rate after the traditional and extensive infertility work-up. WHAT IS KNOWN ALREADY Based on cost-effectiveness studies, which have mainly focused on diagnosis, infertility work-up has become less comprehensive. Many centres have even adopted a one-stop approach to their infertility work-up. STUDY DESIGN, SIZE, DURATION We performed a historically controlled cohort study. In 2012 and 2013 all new infertile couples (n = 795) underwent an extensive infertility work-up (group A). In 2014 and 2015, all new infertile couples (n = 752) underwent a concise infertility work-up (group B). The follow-up period was 1 year for both groups. Complete follow-up was available for 99.0% of couples in group A and 97.5% in group B. PARTICIPANTS/MATERIALS, SETTING, METHODS The extensive infertility work-up consisted of history taking, a gynaecological ultrasound scan, semen analysis, ultrasonographic cycle monitoring, a timed postcoital test, a timed progesterone and chlamydia antibody titre. A hysterosalpingography (HSG) was advised routinely. The concise infertility work-up was mainly based on history taking, a gynaecological ultrasound scan and semen analysis. A HSG was only performed if tubal pathology was suspected or before the start of IUI. Laparoscopy and hormonal tests were only performed if indicated. Couples were treated according to the diagnosis with either expectant management (if the Hunault prognostic score was >30%), ovulation induction (in case of ovulation disorders), IUI in natural cycles (in case of cervical factor), IUI in stimulated cycles (if the Hunault prognostic score was <30%) or IVF/ICSI (in case of tubal factor, advanced female age, severe male factor and if other treatments remained unsuccessful). The primary outcomes were time to pregnancy and the ongoing pregnancy rates in both groups. The secondary outcomes were the number of investigations, the distribution of diagnoses made, the first treatment (started) after infertility work-up and the mode of conception. MAIN RESULTS AND THE ROLE OF CHANCE The descriptive data, such as age, duration of infertility, type of infertility and lifestyle habits, in both groups were comparable. In group A, more than twice the number of infertility investigations were performed, compared to group B. An HSG was made less frequently in group B (33% versus 42%) and at a later stage. A Kaplan–Meier curve shows a shorter time to pregnancy in group A. Also, a significantly higher overall ongoing pregnancy rate within a follow-up of 1 year was found in group A (58.7% versus 46.8%, respectively, P < 0.001). In group A, more couples conceived during the infertility work-up (14.7% versus 6.5%, respectively, P < 0.05). The diagnosis cervical infertility could only be made in group A (9.3%). The diagnosis unexplained infertility differed between groups, at 23.5% in group A and 32.2% in group B (P < 0.001). LIMITATIONS, REASONS FOR CAUTION This was a historically controlled cohort study; introduction of bias cannot be ruled out. The follow-up rate was similar in the two groups and therefore could not explain the differences in pregnancy rate. WIDER IMPLICATIONS OF THE FINDINGS Re-introduction of an extensive infertility work-up should be considered as it may lead to higher ongoing pregnancy rates within a year. The therapeutic effects of HSG and timing of intercourse may improve the fertility chance. This finding should be verified in a randomized controlled trial. STUDY FUNDING/COMPETING INTEREST(S) No funding was obtained for this study. No conflicts of interest were declared. TRIAL REGISTRATION NUMBER N/A.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A concise infertility work-up results in fewer pregnancies

Hamilton

Steeg

Hamilton

et al. 2021

Human Reproduction Open

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“…Eimers found that among 996 infertile patients, those with more than one progressively motile sperm (PMS) in the entire mucus sample had a 330% chance of conception relative to women with no sperm [ 16 ]. Similarly, Hessel found that the presence of one or more progressive forward-moving spermatozoa per HPF among 1624 newly referred infertile women was associated with spontaneous (meaning achieved without medical intervention) and overall ongoing pregnancy rates after 3 years of 37.7 and 77.5% compared with 26.9 and 68.8% after a negative test ( P < 0.001) [ 25 ].…”

Section: Use Of the Pct In The Evaluation Of Infertile Couplesmentioning

confidence: 99%

The postcoital test in the development of new vaginal contraceptives†

Mauck¹,

Vincent

2020

Biology of Reproduction

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Postcoital tests (PCTs) have been used for over a century in the clinical evaluation of infertile couples, and for nearly 70 years in the evaluation of new vaginal contraceptive products. PCTs have been largely replaced by more modern methods in the study of infertility, but they remain the most useful way to obtain preliminary data on the effectiveness of vaginal contraceptive products. The World Health Organization has described important aspects of the procedure. It involves collection of cervical mucus at a certain time point after intercourse and the counting and characterization of sperm found in the mucus. A wide range of progressively motile sperm (PMS) has been associated with pregnancy rates in infertility studies. Eligibility for contraceptive trials includes the requirement that couples achieve a certain threshold number of PMS per high power field at midcycle in a baseline cycle without the test product. The primary endpoint, or definition of a satisfactory result in test cycles, is predefined. A literature review identified 10 PCT studies of vaginal contraceptives involving nine test products. Phase II trials of vaginal contraceptives have not been deemed feasible in the development of any vaginal contraceptive to date. A PCT study of a test product can be predictive of contraceptive efficacy, although ultimate contraceptive effectiveness is influenced by the ease of use of the product, along with patient compliance. PCT results similar to results seen with products that later showed satisfactory performance in efficacy trials is the best indicator of likely success of a test product.

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“…Third, CC possibly induces cervical factor subfertility by influencing the cervical mucus. [17][18][19] We do not know whether the differential monitoring in the women that underwent ovulation induction with CC has had impact on the outcomes, but it is not something we expect. The addition of IUI where monitoring was more strict did not result in significantly higher pregnancy chances.…”

Section: Discussionmentioning

confidence: 99%