Ultrasound Increases the Prognostic Value of the Postcoital Test

Abstract

The prognostic value of the postcoital (PC) test was studied in two groups of women in whom the infertility workup differed only in the way the PC test was timed. Fifty patients were investigated in a traditional way. In this group the PC test failed to have any substantial prognostic value. In a second group consisting of 54 patients, the PC test was timed applying ultrasonographic criteria for ovarian follicular development. This resulted in a highly significant prognostic test. Timing of the PC test by ultrasound enhanced both the reliability and the efficacy of the standard fertility investigation.

Infertility: When is the post-coital test normal? A critical appraisal

“…the chance that No. of motile spermatozoa per HPF required for normality Broer et al (1978) No Buxton (1958) No Collins et al (1984) Yes Glazener et al (1987) Yes Hamilton et al (1986) No Harrison (1981) No Hull et al (1982) Yes Jette and Glass (1972) Yes Samberg et al (1985) Yes Santomauro et al (1972) Yes a couple with an abnormal PCT result will not achieve pregnancy, ranged from 0.58 (Jette and Glass, 1972) to 0.85 (Buxton, 1958;Hamilton et al, 1986). The data suggested that most authors chose their cut-off point between normal and abnormal with a view to maximizing the predictive value of an abnormal test in their study population.…”

“…Hence, an abnormal PCT is best defined as less than one motile spermatozoon per high power field. Key words: cervical factor/infertility/post-coital test/pregnancy Hamilton et al, 1986), seven (Samberg et al, 1985) or even 20 motile spermatozoa per HPF (Jette and Glass, 1972). Not surprisingly, little is known about the relative merits of these definitions and their predictive power.…”

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

“…The role of the PCT as part of the infertility work‐up is heavily debated. Although correct timing of the PCT is crucial for its prognostic value , the Dutch national guideline lacks a specified protocol. Importantly, an optimally timed positive PCT – resulting in expectant management – might be detrimental to couples with a very short window of fertility (≤1 day), as their 12‐month spontaneous cumulative pregnancy rate was only 3.6% .…”

European postcoital tests: opinions and practice

“…These data are known to be rather unreliable for predicting optimal conditions of the cervical mucus (Nulsen et al 1987). More reliable methods, such as follicle measurement by ultrasound and urinary LH or serum oestradiol determinations (Templeton et al 1982; Vermesh et al 1987; Hamilton et al 1986), are used by only 37% of the responding gynaecologists.…”