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Evaluation of the Infertile Couple Part One: By Dr. Barry Jacobs

Posted Sep 11 2009 10:06pm

This is a special 3 part series written by Dr. Barry Jacobs.If you are interested in reading more of his articles, visit Infertility Answers, Inc. where we have articles on pregnancy loss and endometriosis.

Sharon LaMothe


Evaluation of the Infertile Couple

By: Dr. Barry Jacobs

An evaluation of the infertile couple should seek to find all reasonable explanations for the presenting problem. Commonly, an infertile couple has more than 1 problem. It is important to consider even subtle ovulatory problems, as well as male factor issues and to evaluate the anatomy of the woman’s reproductive tract.



When should a couple seek evaluation and treatment for difficulty starting or growing a family? The general rule of thumb is that if the woman is younger than 35 years old, try for a year. If she is over 35, don’t wait more than 6 months to seek professional assistance. There is some good reasoning behind these suggestions. If a young healthy couple has unprotected intercourse (does nothing to prevent pregnancy), there is an 85% to 90% probability she will become pregnant within a year. After the age of 35, a woman’s fertile potential declines dramatically and progressively. In fact, about 70% of women over the age of 35 will require some assistance to become pregnant. After the age of 40, potential for a pregnancy falls off the cliff. Well, it is reasonable advice to try for 6 months to a year, if there is no known problem. Many couples have known issues which impair fertility. To me, it makes no sense to wait a year to pursue medical intervention if you already know there is a problem. Please remember that most issues impairing fertility do not totally prevent pregnancy. Most problems merely decrease the odds that a couple will achieve a pregnancy. It is also important to remember that the most anyone providing professional help can do is shift the odds in favor of the couple being treated. Another point that should be recognized is that most infertile couples have more than 1 problem. I try to try to identify all of them before developing a treatment plan.

Obviously, a woman cannot become pregnant if she does not ovulate. There are all kinds of things you can buy which claim to tell you if you ovulate. Well, not really. Let’s talk about some of them. A free recommendation is to look for copious clear egg white-like mucus coming from your vagina. That is cervical mucus. Production of cervical mucus is stimulated by estrogen. High estrogen levels can produce a lot of cervical mucus, but that really has nothing to do with ovulation. True, estrogens are high right before ovulation, but many women have high estrogen levels without ovulating.

Another technique which some people use to try to detect ovulation is to graph basal body temperatures. When you sleep, your body actually cools off a few tenths of a degree Fahrenheit. If you take your temperature before you get out of bed to use the toilet, even before you kiss your husband good morning, you will record the lowest temperature your body is all day – your basal temperature. The hormone made after ovulation, progesterone will cause basal temperature to raise a few tenths of a degree. There are 2 problems with this technique, other than forgetting to do it. One is that it provides no predictive value. The rise of basal temperature takes place a few days after progesterone production. By then, it is too late to try to become pregnant that cycle. An even greater weakness of the technique is that women can go through all the hormonal changes of ovulation without releasing the egg – ovulating. You won’t become pregnant that way. This is not an uncommon problem for infertile couples.

~Stay Tuned for Part Two~


Dr. Jacobs is a Reproductive Endocrinologist, practicing in Carrollton, Texas, a northern suburb of Dallas. He completed his residency training in obstetrics and gynecology at Baylor College of Medicine in Houston, and remained at that institution to become its first fellow once Baylor achieved accreditation for an advanced training program in Reproductive Endocrinology and Infertility. Dr. Jacobs has served on the faculty of several medical schools and was director of Reproductive Endocrinology at Texas Tech Health Science Center in Amarillo. Currently, in addition to his clinical activities caring for infertile patients and those with recurrent pregnancy loss, he is Chairman of the IVF committee at Baylor Medical Center in Carrollton.
Barry Jacobs, M.D., 4323 M. Josey Lane, Suite #201, Carrollton, TX 75010
www.texasfertility.comPhone: 972-394-9590 Fax: 972-394-9597
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