The interpretation and significance of the fractional postcoital test

The validity of the postcoital test

Opinion is divided on the clinical usefulness of the postcoital (Sims-Huhner) test in diagnosing infertility. To evaluate the validity of this test, we reviewed the world's literature in English and calculated four indexes of validity for each study with sufficient information. The sensitivity of the test ranged from 0.09 to 0.71, specificity from 0.62 to 1.00, predictive value of abnormal from 0.56 to 1.00, and predictive value of normal from 0.25 to 0.75. In addition to the problem of poor validity, the test suffers from a lack of standard methodology, lack of a uniform definition of normal, and unknown reproducibility. The postcoital test lacks validity as a test for infertility.

Correlation of postcoital evaluation with in vitro sperm cervical mucus determinations and ureaplasma cultures

Fifteen trials were completed in 14 couples during an infertility evaluation. The postcoital test (PCT) was accomplished in a standardized manner. Also, standardized determinations of the sperm-cervical mucus penetration test (SCMPT) with the addition of cross-testing (X-test) utilizing bovine cervical mucus (BCM) and normal donor semen (NDS) were done. Male and female samples were also cultured for Ureaplasma urealyticum using U9-B indicator broth and A-7 agar. The PCT and SCMPT agreed in 87% (13/15) of the cases. Utilizing BCM and NDS, where possible, the causative factor was the cervical mucus in 54% (7/13); semen factor in 15% (2/13); both factors in 8% (1/13); and undetermined in 23% (3/13). U. urealyticum cultures were positive in 40% (6/15) of the cases. Analysis of the results revealed: (1) significant correlation between PCT and SCMPT (P less than 0.01); (2) no significant difference among the PCT, SCMPT, and X-test, indicating that the cervical mucus was the causative factor; and (3) no U. urealyticum correlation with the PCT or the SCMPT. Thus, laboratory SCMPT and X-test correlated with the PCT, providing additional information concerning the causative factor in infertility. The U. urealyticum status in cervical mucus and semen cannot be determined from the PCT nor the SCMPT.

A reassessment of the fractional postcoital test

The present investigation was designed to reassess the fractional postcoital test (PCT). Specifically, the study addressed the question of whether the internal cervical mucus sperm count is significantly different from the sperm counts at other cervical levels. By means of standardized methodology, 25 normal postcoital tests were perfoemed on 22 couples. Cervical mucus from three different levels within the endocervical canal was examined for total count, motility, and sperm morphology. No significant difference could be found in these three parameters among any of the cervical levels (p greater than 0.05). Significantly fewer abnormal sperm were found in the cervical mucus when compared to the total abnormal forms in the semen (p less than 0.001). Therefore, while the fractional PCT is a reflection of cervical sperm, this study indicates that the three different cervical levels in the fractional PCT (internal-mid-external) are equally effective in the interpretation of the postcoital test.

The fractional postcoital test: a reappraisal

Postcoital tests (PCTs) were conducted following artificial insemination with either live or dead spermatozoa. The cervical mucus samples were analyzed for sperm counts and acid phosphatase activity. The results indicate that the final distribution of mucus and sperm in the PCT sampling catheter is not truly representative of their original distribution within the cervix. Moreover, PCTs done after insemination with semen containing only dead sperm yield unrealistically high sperm counts and high cervical mucus acid phosphatase levels. This is apparently due to the translocation of semen from the area of the external os into the mucus sample by the sampling catheter. This problem can be largely prevented by removing a plug of mucus from the external os prior to the catheter sampling procedure.