Post Coital Test: which role in Infertility Evaluation.

Used for many years in diagnosing of couple fertility, Post Coital Test (PCT) or Sims Huhner Test is not free

sperm and post coital test

Sperm count and mobility analysis in Post Coital Test

from controversies but still remains an useful and indispensable test in infertility evaluation. The purpose of the Post Coital Test is to evaluate characteristics (quantity and motility) of sperm in cervical mucus after the sexual intercourse.

Personally, I think it is a very interesting  diagnostic tool and I place it in first level (basic) surveys for infertile couple diagnosis. In fact, it provides basic and valuable information “in vivo” on sexual interaction between men and women without any laboratory support.

From a technical viewpoint Post Coital Test consists in a taking of a little quantity of cervical-vaginal secretion with a gentle sterile vacuum system and in its immediate observation with a phase contrast microscope that does not need a biological sample prior preparation that could alterate the medical rendering.

Sample taking is not painful, there is no risk and there is no hospitalization need, and the only discomfort is related to the necessary introduction of a vaginal speculum while the patient is in the gynecological position (typical position taken during the obstetric – gynecological visit). Small samples are then conducted in the vaginal fornix (at the bottom of the vagina), on the cervix surface (external uterine orifice) and to its inside (cervical canal); much less frequently, samples can be taken at intrauterine level or at peritoneal fluid (through an injectione at the Pouch of Douglas). Observation and evaluation of microscopic specimens is generally standardized at a magnification of 40x.

Because the cervical mucus has a very important role in sperm fertilizing capacity, Post Coital Test is recommended around ovulation period(preferably 1-2 days before ovulation) when both the quantity and the physical – chemical characteristics of the cervical mucus are favorable to an optimal sperm survival and motility that also have in their transition trough cervix their fundamental moment of “capacitation”.

After the intercourse, the patient is asked to do not make internal douchings and to go to the hospital after about 2-8 hours. Do not use lubricants and endovaginal medical treatments before the intercourse. Gynecologist must be informed about any medicine taken.

The peri-ovulatory phase (the good time to do the Post Coital Test) can be detected by symptothermal method (basal body temperature collection and evaluation of the cervical mucus characteristics), hormonal dosages (in particular evaluation of urinary LH surge) or by follicle  ultrasound monitoring (the study of follicular growth).

Post Coital Test rendering is based on three types of outcome: POSITIVE, DOUBT, NEGATIVE. It is about the “feconding ability”sexual intercourse under consideration. It is based on a careful evaluation of the cervical mucus characteristics (pH, amount, appearance) with a synthetic evaluation of the Hinsler Index (0 minimum and 12 maximum value) and the quantity and motility of sperm.

A positive outcome is generally given when there is an abundant, clear (transparent), stringy (very distensible) mucus with a pH between 6.5 and 8.5 and in which are aobservable not less than 5 sperm with lively rectilinear and uniform motility in a microscopic observation field at 40x.

A doubt or a negative outcome can be determined by issues such as male Oligoasthenospermia and azoospermia, cervical mucus  alterations (inflammatory conditions, biochemical and quantitative alterations), immunologically factors (anti-sperm antibodies).

Post Coital Test is therefore an important and indispensable couple sterility diagnostic tool. Outcome information on cervical mucus and on sperm (quantity and motility) and their interaction allows the study of one of the most important moments of the fertilization process. Its “in vivo” feature and its non-invasive advantages allowing the study of the sexual relationship in a more natural way.

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Filiberto Di Prospero
Medical Doctor, Consultant in Gynecology and Obstetrics, Endocrinology and Metabolism. Director of Gynecologic Endocrinology Unit at Civitanova Marche General Hospital (Italy). Private clinics in Civitanova Marche, Rome and Milan.

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