Post-Coital Test - Checking Fertile CM, and other non standard tests

[Skyler]

Hi Y'all,

I read the thread on here about "unexplained infertility" which I have as we have been trying for a year (well, about 15 mos now) and all the tests show normal.  Anyway, on that thread someone mentioned a book called Making Babies and I checked it out (thank you!) and the doctor/author talks about a "post coital test," basically checking fertile cervical mucus after you have sex/are inseminated to see if the spermies are still alive.  They can also check for bacteria that could harm sperm, and check the consistency and ph level of the CM. I am going to call my doctor's office tomorrow but I was just wondering if anyone has had that test done and if you had to ask for it, or if the doc suggested it.  I am trying to decide between running more tests to try and find out what is wrong/plus trying natural stuff and just going ahead with clomid alone and then clomid/IUI just to see if it works.  

Anyway, I am kind of stuck between wanting to know if something is wrong/fixing the specific problem and worrying that I am getting older and I have no time to waste.  Anyone else done any non-standard fertility testing, or know about this test?  TIA!!! 

[Laurucha]

I have been wondering about the post-coital test as well. Just about every source I have read says it's part of the basic infertility workup. I asked my RE about this, and she said that they don't normally do the post-coital test. The only reasons she told me where that it is kinda a pain and is not always accurate. But it's the only test they have to determine if your cervical fluid is fertile.

It seems like some doctors (like Sami David, Making Babies author) believe in extensive testing to diagnose before starting treatment. I imagine you are going to find this approach at many of the top (i.e., most expensive) fertility centers. However, the more I think about it, the more I realize that my (HMO-based) doctor's approach is not without merit. Fertility doctors do not have a lot of tools in their arsenal - there are drugs (Clomid and gonadotropins), IUI, and IVF. Why bother with expensive and unpleasant tests, if the treatment is the same? For example, the usual way of dealing with hostile cervical mucus is by bypassing it with IUI. Doing IUI is about as complicated as doing a post-coital test, so why not go ahead and do the IUI? Some of the tests they do are really invasive, such as a laparoscopy to check for endometriosos, which is surgery requiring general anesthesia. On one hand, it would be really nice to know if you have any of the myriad of problems that affect fertility, but on the other hand, it doesn't really matter what is wrong with you if the doctors don't have a treatment for it.

It is hard to make a decision about how much medical intervention to pursue, especially when the clock is ticking. (I am of "advanced maternal age".) I am giving myself just a couple cycles more to give it my best effort the natural way before I go ahead and try Clomid and probably IUI. I would definitely expect far more testing before pursuing IVF, since it is so costly and invasive, but I am not really considering as a possibility anyway.

[AlexisT]

The PCT is no longer routine because it's not very accurate (some couples use it because they do not want to do a sperm analysis for religious reasons, or are only willing to do it if the PCT shows issues). Even expensive clinics often don't bother with it, because they're going to recommend IUI to maximize your chances on medicated cycles, and that bypasses the problem. Since Clomid can cause hostile CM, a good PCT result wouldn't necessarily be helpful in that case.

[Skyler]

Thanks for the responses!  I spoke with the dr's nurse today over the phone and she said basically what the two of you said - That the doctor doesn't consider it helpful and so they don't use it.  I think the procedure is actually more like a pap than an IUI, but who knows how expensive it would end up being if insurance didn't cover it since it is fertility related.  Probably a few hundred dollars.  That dang HSG cost me a grand, out of pocket!  I had no idea it would be that much.  

BTW in that book the Dr suggests a round of antibiotics if there is a bacterial infection, taking Mucinex if your CM is too thick, and using a baking soda douche if it is too acidic, so according to him there are simple remedies in which case an IUI just for one of those reasons might be overkill.  But what I don't get with the baking soda douche is if you are supposed to do it before every round of sex, or just the first time as you are getting in the fertile window, because I would think you wouldn't want to do it the day after sex if you hope that those sperm are going to make it to the egg.  I mention that because I thought of just doing both those things just in case because I don't think either one can hurt, and that way you wouldn't really need the test, unless there was a bacterial issue.  

Argh, it kind of makes my head spin when I start thinking too much about it.  I am also waiting to get some thyroid tests bacak so if my levels are still slightly high I may try thyroid medication before fertility drugs.  But I will probably only wait another 3 mos or so and then do the clomid and then IUI because what if THOSE don't work?  I have already decided against IVF so we would be moving on to adoption, which I have already started looking into because that takes a lot of time and $ as well.  So, I don't want to dawdle too long on any one thing otherwise it will be 5 more years till I have a baby in these arms.  But, then again, I read a post like the one that was just posted about success with acupuncture after 4 years of trying and I think maybe we should try that...   

[babycakes1]

I feel you. I'm all over the board, too, and a big fan of Making Babies.

I was all set to try an IUI (unexplained secondary IF) but talked to my midwife about it. She said made the case that there are reasons that sperm must get to egg on it's own, and that bypassing the process could be sketchy. She talked about this guy Dr. Toth who is all about underlying infections - and that's why CM becomes hostile - and why would you want to put sperm near egg if the underlying conditions aren't optimal for growing a healthy baby. His treatments, antibiotics for a month via IV, are controversial - I found online that some people adore him and some think he's an arrogant fraud. Anyway, all this to say... SUCH MYSTERY! It's so hard to uncover the mysteries of why it takes so long sometimes.

I had a dicey 1st pregnancy and DS was born small - there is a part of me that feels that I just got that healthy baby in despite some underlying issues. And now I wish I could feel confident in a perfect bill of reproductive health. It's a shame that all the RE clinics just focus on the simplest fixes - not that I blame them. I agree wtih PP that if the treatment winds up being the same, it saves time/energy/money to just go straight to what is usually most effective.

I've been doing acu for a few months now, hoping to avoid further intervention. I don't think we'd even do Clomid.

Good luck.

[Skyler]

I know, that is my fear, that if you get pregnant when you have an underlying issue it could affect the pregnancy, and also I worry about taking out the natural selection process sperm goes through on its own, like you midwife said.  But plenty of people have healthy babies with IUI, so if it is between that and not having a baby at all, I think it would be worth the risk.  I am debating making a dr appt and asking them to check for vaginal infections, to try and rule that out.  Or could it be an infection in your body, not just your CM?  I'll probably go ahead and do it, why not, right?  I also saw my naturopath and we have been checking my thyroid hormones and while they are in the "normal" range, they are not optimal for getting preggo, so she finally gave me thyroid medicine.  I decided that I am going to try the medicine for three months and then move on to the medical interventions.  I have to give myself a time limit.  I won't feel 100% great about it, but it is really stressing me out going through this process and I feel like I have tried a lot of things already (one month accupuncture - can't afford that anymore, lots of different supplements, blood work, progesterone, quitting coffee and alcohol, quitting wheat, and now the thyroid meds).  Plus, I could be hemming and hawing and the clomid and IUI won't even work, as they don't for many people.  So I will have more info about how to proceed once I have tried.  Thanks so much for the input and commiseration :)