Post Coital Test (PCT): A Panel Discussion

El Deeb M.W

2. Post Coital Test (PCT):
A Panel Discussion
ByBy
El Deeb M.WEl Deeb M.W
Integrated Fertility Center, Alexandria, Egypt.Integrated Fertility Center, Alexandria, Egypt.

3. Although the value of the clinical PCT is the
subject of considerable debate, because the
cervical factor plays an important role in
infertility evaluations, the PCT of midcycle
cervical mucus is widely used.
Clinical Approach and EvaluationClinical Approach and Evaluation

4. The reasons for this are as follows:
1.It is a qualitative measure of estrogen stimulation.
2.It is only by examining the cervical mucus for
spermatozoa that any direct information about the
adequacy of insemination can be obtained.
3.It provides information as to how sperm are
interacting with the cervical secretions.
Clinical Approach and EvaluationClinical Approach and Evaluation

5. This microscopic examination of postcoital
mucus has been practiced for more than 100
years.
It was originally described by Sims, was
modified by Huhner, and still is commonly
called the Sims-Huhner test.
Clinical Approach and EvaluationClinical Approach and Evaluation

6. The PCT has long suffered from inadequate
standardization because of differences in
variables such as:
-The number of days of abstinence before testing,
-The time intervals between coitus and the PCT,
-The methods of collection, and the criteria of
normality.
Clinical Approach and EvaluationClinical Approach and Evaluation

7. InterpretationInterpretation
Although there is some disagreement
concerning the method of PCT collection,
there is even more disagreement concerning
its interpretation.

8. InterpretationInterpretation
For some investigators, the mere presence of
sperm in the cervical mucus is a normal test;
others require 5, 15, or 20 sperm per high-
power field.

9. PCTPCT
Criteria Finding
Days of abstinence 2
Days of examination Preovulatory (24 h after urinary LH surge, or
1–2 days before basal body temperature rise)
Hours from coitus to exam
Optimal 2–3
Acceptable, if normal 3–8
Possible (often needs to be repeated) 8–24
Number of motile sperm/hfp (400×)
Normal (one semen analysis) 15 or more
Can be normal (need repeated PCT and semen analysis)
Abnormal <5
Cervical mucus Clear, acellular
Spinnbarkeit 6 cm

10. In this cross-sectional study:In this cross-sectional study:
Total number of cases = 108
Total number of PCT done = 279
Age ranged 17-44 years.
Infertility: 1-12 years.

11. PCT negative
(n=134)
PCT positive
(n=145)
Total
(279)
No pregnancy 129 (96.3%) 131 (90.3%) 260 (93.2%)
Pregnancy 5 (3.7%) 14 (9.7%) 19 (6.8%)
Pearson Chi-
Square
X
2
=3.851
P=0.050 NS
As noticed from the table, the difference in pregnancy
approached a significant level (p=0.050).
If pregnancy in positive PCT group reached 15 out of 145
… this would result in a significant difference (p=0.032)

12. Final resultsFinal results
PCT
negative
(n=134)
Dropped cases 16
Induction & failed & dropped 10
Preparing for ICSI 12
On induction 18
PCT positive
(n=145)
Dropped cases 12
Waiting for combined
hystrolaparoscopic
3
On induction & failed &
dropped
6
On induction trial 15

13. Final resultsFinal results
PCT
negative
(n=134)
Hydro done & dropped 4
Hystroscope done  free &
get pregnant by induction
1
Pregnant by induction 3
IUI failed 1
Pregnant by ICSI 1
PCT positive
(n=145)
Hystroscopy  free  then
induction failed and another
trial
1
Spontaneous pregnancy 10
IUI failed 1
Pregnant by ICSI 4
Hystroscopyc done &
dropped
1
ICSI & failed 1
Hydro then dropped 4
Prepare for ICSI 3

14. Insler Score Insler Score
0 1 2 3
volume 0 0.1 0.2 0.3
viscosity high intermediate Little Minimal
Filance (cm) <1 1 a 4 5 a 8 9
Crystallization

No
Crystallizati
on
atypique1er et 2eme
ordre
3eme et 4
eme ordre
cells
(cells/field)
>20 11 a 20 1 a 10 0

15. ConclusionConclusion
In study of Moussalem R, Aboujaoude I,
entitled “Post coital test ; is it worth to do it in
2015. Long-term pregnancy after a positive
and negative post-coital test”. They concluded
the following:

16. ConclusionConclusion
PCT is the only test who define cervical infertility
who represent 15.7% of the all cases
The study give a new argument to continue to
perform PCT. And to do IUI and move to IVF in
PCT- and be more expectant in PCT+

17. ConclusionConclusion
PCT with a control in PCT – case help to explain
the reason of cervical infertility, male infertility
with « normal sperm » and intercourses problems
Repeating the test will help to take a better decision
More studies are needed to confirm these results

18. ConclusionConclusion
PCT is not dead
It is useful to do post coital test in 2015

19. Is PCT is good to evaluate male factor rather than
spermogram?
Question 1Question 1

20. Question 1: AnswerQuestion 1: Answer

21. The result of the PCT can be predicted with data
from history and semen analysis in about half of
the couples with a regular cycle.
If this is confirmed at external validation, and if the
PCT remains an important prognostic and
diagnostic test, our findings suggest that a trial to
evaluate the PCT in the basic fertility work up
‐
would involve performance of a PCT planned from
the history and semen analysis.
Question 1: AnswerQuestion 1: Answer

22. Is PCT a good parameter to evaluate or confirm
good ovulation from mucus parameter rather or
adding to Ultrasound evaluation (follicular
measurement & endometrium thickness )
Question 2Question 2

23. A comprehensive internet search trying to answer
this question resulted in no hits … no literature or
articles or reviews are found.
Question 2: AnswerQuestion 2: Answer

24. Ovulation should be tested based on:
-Ovulation testing.. Body temperature charts, using ovulation
predictor kits and blood tests and ultrasound.
-Ovarian function tests … D3 FSH, D3 E2, U/S and blood
levels of inhibin B.
-Luteal Phase testing.
-Hormone tests.
Question 2: AnswerQuestion 2: Answer

25. Is positive PCT is indicted normal sexual life and
vise versa ..?
Question 3Question 3

26. May be the answer is No … because
-Negative PCT may be due to cervical irritation or infection.
-The test might have also not been performed at the right time.
This happens often during these tests, as it can be hard to get
the timing just right.
-Medications that a woman is on, such as Clomid, can also
affect the results of a post coital test.
Question 3: AnswerQuestion 3: Answer

27. Is +ve PCT affects spontaneous pregnancy?
Question 4Question 4

28. May be the answer is Yes… because
Question 4: AnswerQuestion 4: Answer
Moussalem and Aboujaoude I, found significant
difference in spontaneous pregnancy after 3 years
of follow up (46.59% versus 25%) (p<0.05).
In our study the difference approached significant
level (p=0.05).

29. Thank you