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.
Q: So basically you need a barrage of sperm?
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.
What kind of prognostic tests can be done to give an older couple some indication of the likelihood of pregnancy?
One test is called an FSH level, or follicle-stimulating hormone level. It's a blood test that's done on the third day of the cycle, and it gives us a tremendous amount of information about a patient's egg quality.
Based on that blood test alone, we can help give prognostic information, to tell a couple whether they're going to have a hard time conceiving, or perhaps even an easier time conceiving.
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.
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 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.
Dr. Alan Copperman is an Assistant Professor of Obstetrics, Gynecology, and Reproductive Medicine at the Mount Sinai Medical Center, and is Director of the Division of Reproductive Endocrinology. After earning his degree in medicine, Dr. Copperman performed an internship and residency in Obstetrics and Gynecology at Yale-New Haven Hospital, and then a fellowship in Reproductive Endocrinology at Mount Sinai Medical Center, in New York, where he was the Martin J. Clyman Fellow.
Dr. Copperman is Board Certified in both Obstetrics & Gynecology and Reproductive Endocrinology. He has authored numerous articles and chapters on infertility, endometriosis, polycystic ovarian syndrome, and pelvic surgery.
Copyright © Alan Copperman. Permission to republish granted to Pregnancy.org, LLC.