The Post Coital Test

PCT, Sims Huhner's Test and mucus - sperm exam are different names for Post Coital Test. The Post Coital Test or post intercourse test is a fertility test that determines the ability of sperm cells to survive in cervix mucus (fluid discharge at the lower part of the uterus that opens into the vagina).

Why is the PCT Done?

The Post Coital test may be done as part of an evaluation for infertility. PCT helps to isolate cervical causes of infertility, such as:

• There is a problem with the woman’s cervical mucus
• Sperm antibodies- Antibody reactions occur when the female's body mistakes the sperm for invading pathogens and seeks to destroy them. The male can also rarely produce anti-sperm antibodies.
• The test will show if there are immunity issues that are preventing conception
• The male partner does not want to be tested

When is the PCT Done?

The post coital test is generally done a day or two prior to ovulation (ovulation is the release of a single mature egg from the ovarian follicle). When a woman is ovulating, there is a clinically noticeable change in the mucus secretion. During ovulation, the ovaries produce more oestrogen causing changes in colour, texture and viscosity. These changes make the cervix more hospitable for sperm survival. Oestrogen makes the cervical mucus look clear, more slippery and decreases its viscosity. During ovulation cervical mucus looks just like raw egg whites. The cervical mucus at the time of ovulation is just right for allowing the sperm to reach the egg. While conducting the Post Coital Test the doctor will see how the mucus is affecting the sperm around the time of ovulation.

The Doctor will determine the date of the test by using the woman’s menstrual cycles as a guide. If a woman has been charting her cycles, this information is used to select the date. A woman can herself keep a check on her changing body by analysing the nature of the fluid discharge from the vagina. When the date of the appointment arrives, the couple is instructed to have intercourse about two hours prior to the appointment time.

How to Prepare for a PCT?

• The post coital test must be done within 1 to 2 days of ovulation
• Follow the doctor's instructions for checking basal body temperature and the level of luteinizing hormone (LH) in urine. While checking LH levels, perform the urine test in the mid- to late morning, and do not drink any fluids that morning until the test is completed. If the test shows that the patient is ovulating, call for a doctor's appointment the next day.
• Sexual intercourse should be scheduled about 2 to 8 hours before the doctor’s visit
• Do not use lubricants during sex
• Do not take a bath after sex, but you may take a shower

How the PCT is Conducted

A post coital test is done at the doctor's office. When the patient arrives at the doctor's office, she has to undress from the waist down. There is a gown to drape around her waist. The woman then lies on her back on an examination table with feet raised and supported by stirrups. The test is similar to a smear test.

The doctor puts an instrument with curved blades (speculum) into the vagina, which gently separates the vaginal walls, allowing the doctor to see inside of the vagina and the cervix.

What are the “Risks” of Taking PCT?

There might be a feeling of discomfort when the speculum penetrates the vagina. However, a pelvic examination to collect a cervical mucus sample does not cause problems.

What are the “Results” of the Test?

The doctor takes a sample of the mucus and checks it under a microscope for several factors.

Post Coital test results:
Normal:

• Normal amounts of sperm are seen in the sample
• Sperm are moving forward through the cervical mucus
• The mucus stretches at least 2 inches. (Spinnbarkeit is the medical term used to describe the stretching ability)
• The mucus dries in a fernlike pattern

Abnormal:

• Mucus does not stretch 2 inches
• Mucus does not dry in a fernlike pattern
• No sperm or a large number of dead sperm are seen in the sample
• Sperm are clumped together and not moving normally

What Affects the PCT?

An abnormal test can be caused by abnormal findings of cervical mucus or be due to poor timing. If the test is not timed properly or the woman patient has an irregular cycle, it may not coincide with ovulation. In this case, the test is repeated during the next cycle.