Human Reproduction, Vol. 16, No. 5, 1051-1052,
May 2001
© 2001 European Society of Human Reproduction and Embryology
Letters to the editor |
Routine postcoital testing is unnecessary
Department of Obstetrics, Gynaecology and Reproductive Medicine, Leiden University Hospital, P.O.Box 9600, 2300 RC Leiden, The Netherlands
`Routine postcoital testing is unnecessary', is an official conclusion and a recent policy change of the Practice Committee of the American Society for Reproductive Medicine (2000). European Society of Human Reproduction and Embryology (ESHRE) never recommended the routine test and even in the last postcoital test (PCT) bastion, the Netherlands, another university hospital has abandoned the PCT as part of the routine investigation of the subfertile couple.
Glazener et al. (2000) challenged the existing substantial evidence (Griffith and Grimes, 1990
; Oei et al., 1995) partly based on the powerful design of a randomised controlled trial (Oei et al., 1998), by re-analysing their cohort data published in 1987 (Glazener et al., 1987a). In their recent paper, 207 couples, for whom complete data were available, were studied, free of `noise' as they stated. The original cohort, however, consisted of 318 couples, suggesting that the original paper was performed with incomplete data? The reason for exclusion of 35% of the couples is undisclosed. Absent or non-motile spermatozoa in mucus of good condition was used by us as the definition of a negative or abnormal postcoital test, while Glazener et al. (2000) considered the test negative `if less than one forward-progressing spermatozoon in most (at least five) high power field (HPF)' were found. The definition is unclear as to whether they observed forward-progressing spermatozoon in 2, 3 or 4 HPF. In this respect, the statement in their 1987 paper that the likelihood of conception is greater when the couples with a poor-positive PCT were excluded, is alarming.
Their advice to recommend IUI in case of negative PCT is remarkable, while the same group concluded from data of their randomised controlled trial (Glazener et al., 1987b) that IUI `in couples whose infertility was due to failure of sperm mucus penetration, as defined by negative postcoital tests, appeared to be of no benefit'. Substantial evidence since then has still not been published (Oei et al., 1999). To advocate ICSI as an effective treatment for couples with <3 years infertility and a negative PCT lacks any scientific base.
Balasch (2000), amongst others, concluded, that whether the PCT is normal or abnormal, the treatment nowadays is the same.
Tribute
The announcement of the demise of Professor Michael Hull reached us when we read the publication of Glazener et al. in the September 2000 issue of Human Reproduction. He was an excellent clinical researcher with outstanding integrity and knowledge on reproductive medicine.
Notes
1 To whom correspondence should be addressed 
References
American Society Reproductive Medicine Practice Committee (2000) Optimal evaluation of the infertile female. June 2000
Balasch, J. (2000) Investigation of the infertile couple. Hum Reprod., 15, 2251–2257.
Glazener, C.M.A., Kelly, N.J., Weir, M.J.A. et al. (1987a) The diagnosis of male infertility. Prospective time-specific study of conception rates related to seminal analysis and post-coital sperm-mucus penetration and survival in otherwise unexplained infertility. Hum. Reprod., 2, 665–671.
Glazener, C.M.A., Coulson, C., Lambert, P.A. et al. (1987b) The value of artificial insemination with husband's semen in infertility due to failure of postcoital sperm-mucus penetration controlled trial of treatment. Br. J. Obstet. Gynnaecol., 94, 774–778.[Web of Science][Medline]
Glazener, C.M.A., Ford, W.C.L. and Hull, M.G.R. (2000) The prognostic power of the postcoital test for natural conception depends on duration of infertility. Hum. Reprod., 15, 1953–1957.
Griffith,C.S. and Grimes, D.A. (1990) The validity of the postcoital test. Am. J. Obstet. Gynecol., 162, 615–620.[Web of Science][Medline]
Oei S.G., Helmerhorst F.M. and Keirse M.J.N.C. (1995) When is the postcoital test normal: a critical appraisal. Hum. Reprod., 10, 1711–1714.
Oei, S.G., Helmerhorst, F.M., Bloemenkamp, K.W.M. et al. (1998) Effectiveness of the postcoital test: a randomized controlled trial. Br. Med. J., 317, 502–505.
Oei, S.G., Helmerhorst F.M. and Keirse, M.J.N.C. (1999) Postcoital testing. Br. Med. J., 318, 1007
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