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Postcoital test
The postcoital test (also called the Sims-Huhner
test) is one of the oldest tests used in infertility evaluation. It
involves both the male and the female and is conducted following
intercourse to:- Ensure that full sexual intercourse is taking
place.
- Determine if infertility is due to an
inability of sperm to progress through the cervix.
- Demonstrate adequate oestrogen stimulation
and mucus preparation of the female genital tract.
The couple is advised to have intercourse one or two days before
ovulation is expected, typically during days 11 to 13 of the cycle,
and to visit the clinic the following day. Most centres prefer to
carry out the test between 6-12 hours after intercourse. At the
clinic, a small amount of mucus is painlessly removed from the
cervical canal via a vaginal speculum.
After removal, the mucus is smeared on a microscope slide and
examined under the microscope. On days 11 to 13 of the cycle,
visible mucus should be adequate, copious and crystal clear.
Following intercourse, the mucus is examined for any abnormalities,
and for the presence of active sperm. The number of sperm present
is counted and their movement through the mucus is noted. The
postcoital test is graded ‘good’ or ‘poor’:
- A good result is one in
which at least 5 sperm are seen in each microscope field and are
seen to be actively swimming in a straight line through the mucus.
A good PCT means that sufficient sperm are being produced, that
they are being deposited in the vagina and that they are able to
penetrate the cervical mucus.
- A poor result is one in
which fewer than 5 sperm are seen in each field and/or in which
motility is poor and non-linear. Although a poor result may
indicate a sperm or mucus problem, the most common reason is that
the test was badly timed. If the test is done too early or late in
the cycle, it will be abnormal because at these times the cervical
mucus is thick and relatively hostile to sperm. Only around the
time of ovulation does the cervical mucus favour sperm
transport.
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