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The Postcoital Test

Excessive and unnecessary steps always cost us dearly. Especially, when it comes to medicine.  All tests, analyses and operations prescribed to patients by doctors must be justified and must provide some information as to what, how and when to treat! Unfortunately, one of the peculiarities of Russian medicine has consisted in the prescription of tests for examination and medication for treatment that have not undergone studies accepted in evidence-based medicine. Which is why it is often that one prescribes whatever one was taught to prescribe or whatever one remembers from one’s studies. We have decided to start writing a series of short articles about the most horrendous, sometimes even ludicrous prescriptions that prolong a patient’s examination and treatment and at times, unfortunately, make it impossible to provide effective treatment. 

Let us perhaps start with the postcoital test (Shuvarsky Test) and the Kurzrok-Miller test. They do sound beautiful, I agree. You immediately get the impression that having done these tests, you will lift the veil on the eternal question: “Why do we fail?”  

There are a number of modifications of these tests. Which is already suspicious. Back in my time, when I was giving lectures in different regions of our country as well as of the former Soviet Republics, I was always interested in the modifications of these investigations employed in particular cities. 

Universally, the underlying basis of this test consisted in studying cervical mucus aggression towards sperm cells. In the periovulatory period, it is recommended to patients that they have sex. A few hours later after a sexual intercourse, a patient comes to hospital so that laboratory technicians could determine, with the help of a microscope, the extent to which the sperm cell motility is preserved. 

And now, please pay attention: 

First of all, to make it possible for a doctor to understand when a patient should have an intercourse and then come to hospital, one should carry out folliculometry, ideally, together with hormonal control. US probes, condoms, medical gel will inevitably affect vaginal secretions and the characteristics of cervical mucus. Alright then…

Second, according to the WHO recommendations, the test should be performed in 9-24 hours after a sexual intercourse. In other words, they recommend absolutely nothing.  

I noticed that the smaller the town where I met gynecologists, the faster patients must come to hospital after a sexual intercourse, as requested by their doctors. In Izhevsk, patients should be at hospital in an hour, in Tyumen – in two hours, whereas in Moscow it would still be all right if you came in six hours after sex. This is how city traffic magically affects the integrity of the test. 

Third, to be able to draw a conclusion that the count of rapid progressive spermatozoa in the cervical canal has prognostic value as regards the occurrence of pregnancy, one should first take a look at the way sperm cells move in healthy patients who get pregnant readily. I was not able to find such solid comparative papers. Here I do not count comparison groups consisting of 30-40 people. 

There is a more intricate way of showing a man and a woman how aggressive they are to each other – the Kurzrok-Miller test. For this, we will need an object glass onto which we will drip a drop of cervical mucus and then will cover it with a cover glass. Then, on the one side of the glass, we will place the sperm of the worn-out husband, and on the other – the sperm of a healthy donor. Thereafter, we will watch which one will be the fastest to get to the “centre of the world”. This is indeed a captivating sight!! The effect only increases when, waving the glass victoriously around and giving the husband a pitiful look, we announce that the cause of infertility has been determined and give our truly fantastic advice. Hopefully, you have already understood, which one… 

We can joke all we want but, unfortunately, a lot of spouses get stuck at such recommendations for a long time. Following doctors’ instructions, for several years they use condoms when having sex so that to reduce the aggression of cervical mucus; take Dexamethasone so that to lower immunological aggression, until they develop stomach ulcers; whereas others take their time thinking but then follow a doctor’s direct recommendation…

Wasted time and health are the things you can never get back. We have very well learnt to value every single minute of our time and spend it very rationally. Once we think about the fact that the minutes of every patient coming to our office are equally priceless, half of the medical nonsense that fills our heads and that we generously share with our patients will disappear at once. IRREVOCABLY

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