The postcoital test in WHO test class II anovulatory women. Useful or redundant?

Velde, M. van der (2013) The postcoital test in WHO test class II anovulatory women. Useful or redundant? thesis, Medicine.

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Abstract

Background: The postcoital test (PCT) is used in the fertility work-up in subfertile couples. It is the method of choice for diagnosing a ‘cervical factor’ in infertility. Although the many studies in the ovulatory subfertile population, the value of the PCT in predicting fertility is still controversial. Whether this test has a predicting value of fertility in the anovulatory subfertile population can be questioned. The aim of present prospective follow up study was to assess the prognostic value for pregnancy of the PCT in WHO II anovulatory women, ovulatory with clomiphene citrate (CC). Methods: In three centres, we prospectively studied a cohort of women with WHO II anovulation who started ovulation induction with clomiphene citrate. Follow up started immediately after starting ovulation induction and ended at six ovulatory cycles. A PCT was performed in one of the first three ovulatory cycles. The primary outcome measure was ongoing pregnancy rate, defined as a vital intrauterine pregnancy, at least twelve weeks of gestation. Time to pregnancy was censored at the day of the last ovulatory cycle or at start of any other treatment. Kaplan-Meier curves for the occurrence of intra-uterine pregnancy were constructed for women with a positive result of the PCT and for women with a negative result. Log rank tests expressed the associations between PCT and the occurrence of an ongoing pregnancy. Results: We included 251 women and 152 women underwent a PCT. Of these, 135 women had a reliable result of the PCT. A conception within six months after the first ovulatory cycle occurred in 131 (52%) women and in 74 (49%) women after PCT. At the PCT, 107 (79%) showed a positive result and 28 (21%) showed a negative result. In the PCT group with a positive result we registered 55 clinical pregnancies and 45 ongoing pregnancies (82%). In the PCT group with a negative result we registered 11 clinical pregnancies and 10 ongoing pregnancies (91%). Within 6 cycles after the PCT 45 of 107 women (42%) with a positive PCT and 10 of 45 women (22%) with a negative PCT reached an ongoing pregnancy (RR 1.29, 95%CI 0.707 – 2.342). For women with a negative result of the PCT the cumulative pregnancy rate was not statistically significant different with a log rank of 0.19 compared to women with a positive test. Total, for 99 women the PCT was not performed. Of these women 41 became pregnant before performing the PCT which is 17.1% of all women who became ovulatory. The mean total cycles in the positive group was 4.4 and the mean total cycles in the negative group was 5.1. With the independent sample t-test no significant difference was found in total cycles between these two groups. Conclusion: Analysis showed no significant difference in chance on clinical and ongoing pregnancy between women with a positive PCT result and a negative PCT result. Even so, there was no significant difference in time to pregnancy between both groups. Performing a PCT would lead to additional burden to women and additional unnecessary costs. We recommend to not implement the PCT in the general fertility work-up for WHO II anovulatory women.

Item Type:	Thesis (Thesis)
Supervisor name:	Hoozemans, Drs. D.A.
Supervisor name:	Nahuis, Drs. M.J. and research department Obstetrics/Gynaecology AMC Amsterdam & A
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:01
Last Modified:	25 Jun 2020 11:01
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2106

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