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Published on: 7/1/2001
Last Visited: 2/20/2002
Jacqueline N. Gutmann, MD
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Dr. Jackie Gutmann is an Assistant Clinical Professor at the Thomas Jefferson University School of Medicine in Philadelphia.She also practices at the Women's Institute for Fertility, Endocrinology and Menopause.
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JACQUELINE N. GUTMANN, MD: Generally speaking, if a woman is under the age of 35 and she has been trying to get pregnant for a year, it's time to start taking steps to evaluate why she has not conceived.
If a woman is over 35, or if she has previously gotten pregnant, we shorten that interval to six months.In addition, if somebody has known abnormalities-if they have blocked tubes, if they know they don't have regular cycles or don't ovulate, or if their male partner has had chemotherapy-then there's no reason to wait for an evaluation and treatment.
So if couples are planning to get pregnant, their entire medical histories need to be examined to determine what factors may be causing problems?JACQUELINE N. GUTMANN, MD: That's right.It is extremely important to really talk to your patients.It's not just a matter of doing this test or that test, but actually finding out what they have been through.
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JACQUELINE N. GUTMANN, MD: One of the most common causes is related to the sperm-either they are low in number or motility, or they're not normal in appearance.Sometimes, the sperm just simply do not have the capacity to fertilize the egg.
From a female standpoint, the most common things that cause infertility are irregular menstrual cycles and tubal disease-a condition in which the tubes are blocked, either from previous infection or previous pelvic surgery.
You mention irregular cycles.What are some of the conditions that can cause this problem?
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JACQUELINE N. GUTMANN, MD: Certainly thyroid conditions can play a role in infertility.We often evaluate the thyroid as part of an infertility evaluation.And, on occasion, we do find evidence of an underactive thyroid that a patient would have otherwise not noticed.
What about structural problems, blocked fallopian tubes, for instance?JACQUELINE N. GUTMANN, MD: The most common reason for blocked fallopian tubes is scarring from a prior pelvic infection.Sometimes, women know that they had an infection, but more often than not, they don't.For example, chlamydia, a very common, and often asymptomatic, sexually transmitted disease can cause pelvic infection and subsequent scarring.
In terms of male infertility, you talked about sperm count and sperm mobility.Explain to us why those are so important.JACQUELINE N. GUTMANN, MD: You need a large number of sperm deposited in the vagina in order for conception to take place.It takes more than a single sperm to be able to fertilize the egg; only one sperm actually gets in, but you need a number of sperm clearing the way to allow that single sperm to enter.Also, when the ejaculate is deposited in the vagina, some of it does leak out, and that's perfectly normal.
So basically you need a barrage of sperm.JACQUELINE N. GUTMANN, MD: You need a barrage of sperm, and they need to swim.The sperm have to make their way from the vagina into the cervix, through the cervical mucus, through the uterus and then to the right or the left fallopian tube, where they will ultimately encounter an egg.
That's quite a long path, and a lot of things can happen.JACQUELINE N. GUTMANN, MD: It is.And these guys are real little, so it's a ways for them to travel.
What kind of prognostic tests can be done to give an older couple some indication of the likelihood of pregnancy?
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JACQUELINE N. GUTMANN, MD: Unfortunately, as we age, we do become less fertile, and it's not as simple as, "I'm fit and I'm healthy and I'm sure I'm going to be able to get pregnant."
However, in terms of aging, we all age at our own rates.One 40-year-old woman may be very fertile, one 30-year-old woman may have very unhealthy eggs.That is genetically predetermined and hard to control.
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Jacqueline N. Gutmann, MD
Thomas Jefferson University
Dr. Gutmann is Assistant Clinical Professor of Obstetrics and Gynecology at the Thomas Jefferson University School of Medicine and an attending physician at Thomas Jefferson University Hospital.She is a graduate of Union College and the Yale University School of Medicine.She completed her residency in Obstetrics and Gynecology, as well as fellowships in Reproductive Endocrinology and Menopausal Health Care, at the Yale-New Haven Hospital, where she was awarded the Irving Friedman award for excellence in patient care.
Prior to joining the Woman's Institute, Dr. Gutmann was a Robert Wood Johnson Clinical Scholar and an attending physician at the Yale-New Haven Hospital.She is Board Certified in Obstetrics and Gynecology and Reproductive Endocrinology, and is a member of the American Society for Reproductive Medicine, American College of Obstetrics and Gynecology, the North American Menopause Society, and Resolve.She has published numerous articles on infertility, in vitro fertilization, endometriosis, estrogen, and hormonal replacement therapy, and has presented her research in a variety of national and international forums.
Read this faculty member's articles
The First Steps to Achieving Fertility
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The Steps to Achieving Fertility
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