“Post coital” literally means “after intercourse” which is when this test is conducted.  The couple has intercourse at home usually between cycle days 12 and 15.  After intercourse, the female comes to our office and a sample of her cervical mucus is taken for microscopic examination.

The post coital test allows us to examine sperm after they have been exposed to the cervical mucus; the same as occurs in “nature”. If numerous dead or non- moving sperm are present it could indicate the presence of female, or rarely male, antisperm antibodies. These antibodies are formed by the immune system and mistake sperm for invading pathogens, such as virus and bacteria, and seek to destroy them. Normal sperm are active, have a characteristic shape, and swim in straight lines through the mucus. If the mucus is too thick, the sperm cannot successfully make their passage to the uterus.

A common treatment for cervical mucus “problems” is intrauterine insemination (IUI) using fertility drugs (FSH) to stimulate the ovaries.  Sperm are specially prepared and washed in a variety of solutions. This is a critical stage as unwashed sperm can cause very serious allergic reactions. Once the sperm are prepared, they are placed in a small catheter for insertion into the uterus around the time of ovulation.

The endometrium is the inside layer of the uterus where the embryo embeds and continues its development.  The uterus must be free of obstructions such as fibroids or significant congenital abnormalities. Endometrial cells have the capacity to rapidly grow and develop under the influence of the hormones estrogen and progesterone. This “growth” results in the increased vascularity and endometrial width which is needed to support a developing embryo.

As healthy follicles develop, they produce estrogen and the leftover follicular structure on the ovary; know as the corpus luteum, produces progesterone.

A small sample of the endometrium is taken during the luteal phase of the ovulatory cycle approximately twelve days after the LH surge. The biopsy is examined to see if the cellular development of the endometrium “matches” what is predicted for day the sample was taken.  If endometrial cellular development matches the biopsy, the biopsy is termed “in phase”. If the biopsy shows less than predicted development for that cycle day, the biopsy is said to be “out of phase” and a luteal phase defect may exist.

Progesterone is administered in the next ovulatory cycle to correct the luteal phase defect.

Fertility Tests