Postcoital testing in anovulatory women.

Objective:

To determine the value of a post coital test (PCT) in the basic fertility work up in WHO class II subfertile women ovulatory after clomiphene citrate (CC).



Design:

A prospective follow up study.



Patients:

Patients with a history of subfertility and WHO class II anovulation, with normal prolactin (PRL) and thyroid stimulating hormone (TSH) levels, ovulatory after clomiphene citrate.



Inclusion criteria:


1. Age > 18 years;

2. Ovulation after incremental CC doses from 50 to 150 mg starting on day 3-5 for 5 days;

3. Partner with a total motile sperm count above 1 million.

Exclusion criteria:

1. Abnormal PRL or TSH value;

2. Known bilateral tubal pathology.



Intervention:

A basic fertility work up including a PCT.



Main outcome measure:

Pregnancy rates in women with a positive PCT compared to pregnancy rates in women with a negative PCT within a time horizon of six months.

Pregnancy rates will not differ between patients with a positive and negative result of the PCT.

At the pereformance of the postcoital test and after six months.

At least one PCT is performed during the basic fertility work-up. The test should be planned based on the basal body temperature (BBT) curve, ultrasound findings or cycle history. In couples where the timing depends on the BBT and cycle length, the PCT is scheduled the day before the expected ovulation. In cases where the timing depends on ultrasound findings, the PCT is performed once the dominant follicle is ¡Ý 18 mm. The couple is asked to have intercourse before the appointment. The PCT is performed by cleaning the cervix, followed by suction of endocervical mucus using a 1 ml disposable syringe. Clarity and spinnbarkeit are assessed aiming for an optimal length of ¡Ý 7 cm. The PCT is judged to be normal if at least one progressive motile spermatozoon is seen in one of five high power fields at 400x magnification. All other PCT results are considered to be abnormal. If progressive motile spermatozoa are absent the test is scheduled again two days later or following the confirmation of a dominant follicle on ultrasound.