BMJ 1998;317:502-505 ( 22 August )

Papers

Effectiveness of the postcoital test: randomised controlled trial

S Guid Oei, gynaecologist, ^a Frans M Helmerhorst, senior lecturer, ^b Kitty W M Bloemenkamp, registrar, ^b Frederieke A M Hollants, medical officer, ^b Debbie E M Meerpoel, medical officer, ^b Marc J N C Keirse, professor. ^c

^a Department of Obstetrics and Gynaecology, Saint Joseph Hospital, 5500 MB Veldhoven, Netherlands, ^b Department of Obstetrics, Gynaecology and Reproductive Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, Netherlands, ^c Department of Obstetrics and Gynaecology, Flinders University of South Australia, Adelaide, SA 5042, Australia

Correspondence to: Dr Helmerhorst helmerhorst{at}rullf2.medfac.leidenuniv.nl

Objectives: To investigate the impact of the postcoital test on the pregnancy rate among subfertile couples and on the number of other diagnostic tests and treatments.
Design: Randomised controlled study.
Setting: A university and two non-university teaching hospitals in the Netherlands.
Subjects: New couples at infertility clinics, 1 March 1993 to 1 October 1995; randomisation to an intervention group (series of infertility investigations that include the postcoital test) or to a control group (series excluding the test).
Main outcome measure: Cumulative pregnancy rate.
Results: Of 736 consecutive new couples, 444 fulfilled the inclusion criteria and consented to participate (intervention group, 227; control group, 217). Treatment was given more often in the intervention group than in the control group (54% v 41%; difference 13% (95% confidence interval 4% to 22%)). Yet cumulative pregnancy rates at 24 months in the intervention group (49% (42% to 55%)) and the control group (48% (42% to 55%)) were closely similar (difference 1% (9.0% to 9.0%)).
Conclusion: Routine use of the postcoital test in infertility investigations leads to more tests and treatments but has no significant effect on the pregnancy rate.

Key messages The postcoital test dates back to 1866  The test is widely used in infertility investigations but has limited diagnostic potential and poor predictive value Treatments for abnormal test results vary but have not been shown to be effective This first randomised controlled trial comparing infertility investigations with and without the postcoital test showed closely similar cumulative pregnancy rates at 24 months Incorporation of the postcoital test in standard infertility investigations increases the number of tests and treatments but has no effect on the pregnancy rate

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© BMJ 1998
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William Forbes Hendry
bmj.com, 25 Aug 1998 [Full text]

Postcoital testing

M G R Hull
bmj.com, 16 Sep 1998 [Full text]