EVALUATION OF THE POSTCOITAL TEST IN CYCLES INVOLVING EXOGENOUS GONADOTROPINS

Objective: To evaluate the hypothesis that a postcoital test, optimall y performed in the periovulatory period of cycles in which gonadotropi n-induced superovulation was used, correlates with cycle fecundity. Me thods: Of 1135 total consecutive cycles, 367 first cycles were analyze d from the reproductive endocrinology and infertility service of a uni versity medical center. This referral population had a mean age of 34. 6 years for the female partner, a nulliparity rate of 81%, and a mean length of infertility of 4.8 years. Postcoital tests were performed 36 -40 hours after hCG administration in gonadotropin-stimulated cycles. Clinical pregnancy was defined as fetal cardiac activity as seen on tr ansvaginal ultrasound examination. Results: Couples with no sperm obse rved per high-power field in the cervical mucus achieved a 16% fecundi ty rate (21 pregnancies in 129 cycles), one to ten sperm a 18% fecundi ty rate (28 pregnancies in 154 cycles), and more than ten sperm a 15% fecundity rate (13 pregnancies in 84 cycles). There was no significant difference between groups (n = 367, P = .85); the power to detect a s tatistically significant difference was .82. As validation of optimal cervical mucus, fecundity rates were compared with these postcoital te st values across the entire range of peak periovulatory serum estrogen levels, and no correlation was seen (P = .61, .86, and .96 for estrog en levels of 201-500, 501-1500, and 1501-3433 pg/mL, respectively). Co nclusion: With precise periovulatory timing and supraphysiologic estro gen levels optimizing qualitative cervical mucus characteristics in go nadotropin-induced cycles, the number of sperm observed per high-power field does not correlate with cycle fecundity. (C) 1997 by The Americ an College of Obstetricians and Gynecologists.