Long-term ongoing pregnancy rate and mode of conception after a positive and negative post-coital test.

OBJECTIVE

Many fertility clinics have decided to abolish the post-coital test. Yet, it is a significant factor in prognostic models that predict the spontaneous pregnancy rate within one year. The aim of this study was to evaluate (1) the long-term outcome of infertile couples with a positive or a negative post-coital test during their fertility work-up and (2) the contribution of the different modes of conception.

DESIGN

Retrospective cohort study.

SETTING

Three fertility clinics in the Netherlands, of which two are secondary care training hospitals and is a one tertiary care academic training hospital.

POPULATION: 2476 newly referred infertile couples, where a post-coital test was performed in 1624 couples.

METHODS

After basic fertility work-up, couples were treated according to the national treatment protocols.

MAIN OUTCOME MEASURES: Spontaneous and overall ongoing pregnancy rate.

RESULTS

The spontaneous and overall ongoing pregnancy rates after three years were 37.7 and 77.5% after a positive post-coital test compared with 26.9 and 68.8% after a negative test (p < 0.001). Even in couples with severe male factor infertility (total motile sperm count <3) (p = 0.005) and mild male factor infertility (total motile sperm count 3-20) (p < 0.001), there was a significantly higher spontaneous ongoing pregnancy rate, justifying expectant management.

CONCLUSION

After a follow-up of three years a positive post-coital test is still associated with a higher spontaneous and a higher overall ongoing pregnancy rate, even in couples with severe male factor infertility.