PCT is an important multipurpose clinical test for fertility assessments with wealth of information. It excludes cervical hostility and provides useful information on State of cervix and nature of its secretions, Presence of cervico-vaginal infection which needs to be treated before any fertility test or treatment and Sperms without embarrassments of male to collect and deliver semen. It is natural and convenient. It also Detects coital or ejaculation difficulties and as an additional benefit status of ovarian hormones and the luteinization can also be judged.
Technique: Once the mucus is observed to be fertile, the couple is advised for sexual intercourse any time of the night and attends the next day. It is important that 6-8 hours lapse between coitus and the test so that there is sufficient time for sperm cervical mucus interaction.
Mucus if fertile is taken from inside the cervix and placed on a glass slide. Simplest method of collecting these secretions is with a long artery forceps, which is available in any situation. It can also be drawn with special mucus extraction syringe, pipette with a rubber dropper or insulin syringe. Some secretions are also taken from the vagina. Cover slips are placed on mucus and the secretions. The slide is then examined under high power of the microscope. Where microscope is not available even a magnifying lens can be used.
If there are many active sperms with forward progressive motility (Grade-3) PCT is positive indicating:
- Cervical secretions are favorable for the ascent of the sperms and there is no cervical hostility.
- Husband has good powerful sperms, capable of going up from vagina into the uterus and onwards. Male factor is less likely to create difficulty in conception.
If there are sperms in the cervical mucus but NOT actively motile, it means.
- Sperms may be weak, male factor is suspected.
- Cervical secretions not favorable for the ascent of sperms, cervical hostility may be suspected.
If there are NO sperms in the cervical secretions, vaginal secretions are examined also under microscope. If sperms are found in vaginal secretions, the possibilities are:
- The sperms are too weak to ascend.
- There is strong cervical hostility to the sperms.
- Vaginal flora is strongly spermicidal and immediately destroys the sperms. Vaginal infection should be excluded.
If sperms are absent in cervical mucus as well as vaginal secretions, the possibilities are that either the man did not ejaculate, only had orgasm or he has azoospermia (no sperms in semen).
Post coital test is a useful test. It has been abandoned and opposed by many finding it to be inconvenient to the couple and the physician rather than its merits. It is sad to condemn this very useful bioclinical test because the present day physician does not find it convenient to perform.
The woman is asked to attend in the preovulatory phase for ultrasonic evaluation. PCT is performed at the same time which is quite convenient to all. The best use of PCT is if the fertility clinician personally or clinical assistants perform it in the premises.
Postcoital test is recommended the first test for male factor. Semen analysis is only done if the PCT is of lower grades. In fact this is the first fertility evaluation. These are the most favorable moments for fertilization as well. Prof Saad Rana’s 5 grades are useful for their comparisons and prediction of fertility potential. Grade-I has the best potential and grade-V the least. A PCT of grade-I and II correlates with good semen values on semen analysis. If PCT is negative, i.e., no sperms are found in cervical mucus, MPT is performed and the semen analyzed at the same time.