Human Reproduction, Vol. 15, No. 9, 1953-1957,
September 2000
© 2000 European Society of Human Reproduction and Embryology
The prognostic power of the post-coital test for natural conception depends on duration of infertility
1 Health Services Research Unit, University of Aberdeen, Aberdeen and 2 University of Bristol, Division of Obstetrics and Gynaecology, Bristol, UK
Controversy about the value of the post-coital test (PCT) has prompted us to re-analyse data from 207 couples, originally studied between 1982 and 1983, with at least 12 months' infertility at presentation, complete diagnostic information and exclusion of female factors, to clarify the effect of duration of infertility on the prediction of conception. In couples with less than 3 years infertility and a positive PCT, 68% conceived within 2 years compared with 17% of those with a negative result. After 3 years, corresponding rates were 14% and 11%. The relative risks of conception [95% confidence interval (CI)] calculated using the Cox's proportional hazards model were 0.23 (0.12–0.43) for a negative PCT (reference positive PCT) and 0.25 (0.13–0.51) for more than 36 months infertility (reference 12–23 months). Semen analysis had no extra predictive power given the duration of infertility and the PCT. The PCT is an effective predictor of conception where defined female causes of infertility are absent and duration of infertility is less than 3 years. Once infertility is prolonged (beyond 3 years) the conception rate is low even with a positive test because a large proportion of couples remaining childless so long have true unexplained infertility. Use of the PCT will enable clinicians to allocate scarce, expensive and invasive resources effectively.
Key words: cumulative conception rates/duration of infertility/post-coital test/semen analysis/sperm function
* After a short illness, Michael Hull, Professor of Reproductive Medicine and Surgery in the Division of Obstetrics and Gynaecology, University of Bristol, died on 22 November, 1999, aged 60 years. He went to Bristol from London in 1976 as Consultant Senior Lecturer in Obstetrics and Gynaecology with a developing reputation in clinical reproductive endocrinology from his time in London and elsewhere. His contributions to knowledge and practice of reproductive medicine, particularly in all aspects of male and female infertility, brought international renown to his unit. He was appointed to a Personal Chair in 1989. He brought strong ethical principles to his research and clinical practice and campaigned locally and nationally for public understanding and funding of infertility services.
3 To whom correspondence should be addressed at: Health Services Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.E-mail: c.glazener{at}abdn.ac.uk
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