The treatment for an abnormal postcoital test result is generally placement of sperm above the cervical mucus within the uterine cavity (intrauterine insemination). This effectively will bypass the cervical mucus (barrier).
Some infertility specialists attempt to correct sperm mucus interaction abnormalities by identifying (and selectively treating) the apparent problem. In my experience, these efforts have a low rate of success (success being a subsequent normal postcoital test or fertility) and most of my infertility patients are unwilling to wait for months to diagnose, treat and recheck the cervical mucus to document an improvement. Specific treatments that can be considered in an effort to improve poor mucus quality include
(1) viscous thick mucus:
guiaifenesin by mouth. This is a mucolytic agent that acts to thin out or lyse mucus. It is the active ingredient in Robitussin and some other cold medications that act to thin intranasal mucus (by breaking up the mucus so that it can be expelled)
(2) scanty mucus:
estrogen preparation by mouth. Premarin in either 0.625 mg or 1.25 mg dosing for 8 to 9 days prior to ovulation may increase the amount of mucus and possibly its quality. This does not generally work in the presence of Clomiphene citrate treatment since this medication works partially by occupying and downregulating estrogen receptors.
(3) acidic mucus:
douching with an alkalinic nontoxic solution such as sodium bicarbonate (1 tablespoon of baking soda into 1 quart of water) to increase the pH of the mucus 30 to 60 minutes prior to intercourse. This has been widely used with mixed success.
(4) yellow purulent mucus:
appropriate antibiotics to treat a presumed or documented infection should be used.
(5) sperm wiggling in place:
antisperm antibodies are difficult to effectively treat. Steroids may inhibit the immune system in general and production of anti sperm antibodies in particular. These steroids have potentially serious complications and unclear benefit in this context.
(6) use of lubricants:
discontinuation of lubricants (with the possible exception of vegetable oil) is recommended while attempting fertility. Most lubricants including KY jelly and surgilube are toxic to sperm and can interfere with their survival. Astroglide is a commercially available synthetic lubricant that is apparently not associated with sperm toxicity.