The Postcoital test (PCT) is one of the oldest tests used to investigate infertility and has been used for over a century now. This is a pretty obsolete test and not many doctors do this any longer. It’s because the test provides very little information. In PCT, timing is everything and it has to be done in the preovulatory period; it’s when there is a profusion of clear, cervical mucus.

If you’re using an ovulation predictor kit, it will be the determining factor of when you should have intercourse. You should have sex that morning and you shouldn’t use any lubricants or a douche. It’s okay to take a shower though. You would also have to schedule an appointment with your doctor and come to the clinic after you have had sex.

The gynecologist examines a very small sample of the cervical mucus under a microscope, a few hours post sexual intercourse. It’s not really a great  thought to  rush to the clinic soon after you have had intercourse, and then allow the gynecologist to examine your insides ! Little wonder then that most women have an intense dislike for this test

Postcoital test (PCT)- Some facts

  • During the internal examination, the mucus is sucked painlessly from the cervical canal
  • In most instances, this test has to be done around 6-12 hours post sex , however  the timing isn’t that critical
  • If the doctor finds normal live sperm swimming around in the sample, the test is said  to be positive
  • The sperm should ideally be swimming vigorously and in a straight line
  • The test is said to be positive if many normal live sperm are seen swimming in the mucus sample

A positive Postcoital test (PCT) can be very reassuring and it implies that:

  • The husband is likely to be producing enough normal sperm
  • Intercourse results in semen being deposited in the vagina
  • The cervical glands are healthy
  • Sufficient estrogen is being produced before ovulation, suggesting that ovulation is normal
  • There are no antibodies in the mucus, that are hostile to the sperm

In case this test is negative, there could be a number of reasons for it, such as:

  • The PCT wasn’t done at the best time; it may have been done too early/too late in the cycle. Wrong timing is the most common reason for a negative test and can even cause repeated negative tests.
  • No ovulation the month of the test – probably caused by the strain or stress of making love at a specific time
  • The sperm count was poor; men with persistently low sperm counts, or those with poor motile sperm, may be responsible for a negative PCT.
  • Abnormality of the cervix - a chronic infection in the cervix may prevent production of adequate mucus; women with a scarred cervix may not produce enough mucus either
  • Patients who have had surgery on the cervix (for example, cervical conisation) often have this problem.
  • The cervix is producing antibodies to the sperm
  • Medications such as clomiphene, tamoxifen, progesterones and danazol (drugs used for infertility problems), can interfere with the production of good mucus.

The aspect to keep in view here is that a negative test is meaningful only if it is repeatedly negative under perfect conditions. We don’t do the PCT test at the Malpani Infertility Clinic, as we feel that the information it provides is very limited and that it doesn’t really affect the treatment plan.

Not happy with the attention you are getting from your IVF clinic? Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you!

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.

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