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The post-coital test (Hünher test)

letto 12277 volte | autore: Claudio Manna, ginecologo specialista in fecondazione assistita (vai al curriculum)


Normally, for the greater part of the female menstrual cycle, spermatozoa cannot enter easily into the uterine cavity.

Before ovulation, however, entrance is easy.

If the hormonal secretions of the woman are normal and the cervix works well, the mucus changes in the days that precede ovulation to allow the spermatozoa to enter.  If the neck of the uterus has problems (e.g. cervicitis) or the hormonal secretions are not adequate the mucus is scanty, viscous and remains impermeable for the spermatozoa ,therefore, the meeting of the ova and the spermatozoon are not very likely to occur.  These abnormalities can cause infertility, this is why it is essential to verify the quality of the cervical mucus and the mobility of the spermatozoa in its presence.

The post-coital test, or Hunher test, is a laboratory examination that facilitates the study of the properties of the cervical mucus in the pre-ovulatory period, and allows us to upraise the mobility of the spermatozoa of the partner within the mucus. It is a painless exam, which is part of the initial routine of the infertility diagnosis. Since the test is interpretable, it is necessary to adhere scrupulously to all the conditions of its realisation: the test should be effected during the pre-ovulatory period( that is one or two days before the expected date of ovulation). To ascertain the exact moment in which to carry out the test, various methods can be used. Compile a basal body temperature curve, perform follicular monitoring or measure the hormonal dosages or perform a urine ovulation test. Often several systems are combined.  Anyhow,  even the woman herself is generally aware of the presence of cervical mucus and informs the gynaecologist who then performs the necessary  tests one of these being a quality and quantity test of the cervical mucus (“cervical score”).

In every case, the date of the last menstruation is noted, counting from the from the first day of blood loss.  For the man, 4 or 5 days of sexual abstinence are necessary in order for the quality of the sperm to be optimum.  Sexual intercourse has to take place 6 – 12 hours before the collection of the mucus, which take place in the laboratory where the number and the mobility of the spermatozoa in the cervical mucus will be tested.  Intercourse has to be followed by a rest period where the woman remains lying down for 20-30 minutes, and it is necessary not to wash the genitals before the collection of the mucus.

The collection of the mucus is painless and risk free and does not require admission into hospital or anaesthetic.  The woman is in a gynaecological position, and after the insertion of the speculum the mucus is drawn, especially endo-cervical mucus, from the cervical channel.  The mucus collected is immediately taken to the biologist, who examines it with a microscope to check the quantity and the viscosity, the transparency, cristalisation pattern  and of course the pH.  Any signs of infection are also checked for (the presence of germs and leucocytes , white blood cells)  Naturally the spermatozoa are counted especially the mobile ones taking note of the type of motility.

The results

Positive test: everything is normal because the mucus is abundant, it has normal viscosity, it is slimy, transparent and the cristalization results are normal ( under the microscope it presents with the typical fern form).  The pH is between 6.5 and 8.5, there are no germs or leucocytes and there are normally 5 spermatozoa with normal mobility (straight and fast) within the visual range.

Negative test: poor quality mucus.  Scanty mucus, with an acidic pH, opaque with poor cristalization. The live mobile spermatozoa are few.  In this case it has to be verified whether the test was really performed in the pre-ovulatory period, and if it is not so, the test is repeated two or three days later or in the following cycle.  If the quality of the mucus does not improve after two consecutive  post-coital tests, hormonal stimulation is prescribed in order to improve the quality.  In the presence of a bacterial infection antibiotic or antiseptic treatment is prescribed before another test is performed.  A reason for the negativity of the test could be that the cycle was not ovulatory and hormonal stimulation of the ovaries can normalise everything.

A negative test with good quality mucus: All the physical and chemical qualities of the mucus are normal and there are no signs of infection, live mobile sperm are absent or few or the mobility of the spermatozoa present is abnormal ( fixed with an oscillating movement).  In this case it has to be verified if sexual intercourse occurred in normal conditions and verify if the spermiogram is normal.  In the case of a normal spermiogram , the mucus or the mucus/spermatozoa interaction is the likely cause of the negative test results.  At this point we proceed to perform a  cross penetration test to find out if the abnormality is from the spermatozoa or the mucus.  The behaviour of the spermatozoa for instance can be verified in bovine mucus.  This last test could raise doubts as to the presence of  anti-spermatozoa immunisation in the mucus or the sperm itself, that is the presence of anti-spermatozoa antibodies.  The presence of antibodies is however are rare occurance.

If hormonal stimulation has not produced positive effects we then move on to intrauterine insemination.

Disclaimer: the information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician.

venerdì 21 marzo 2008

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