First, don’t forget the foreplay. Just because you have a job to do now doesn’t mean that you should make this too much like work. For one thing, you want to try to keep sex from becoming a stressor. For another, sexual stimulation improves cervical mucus and increases the flow of hormones, which in turn increases fertility. In addition, one study found that men who were turned on by a partner had higher sperm counts than those who masturbated by themselves. It’s in your best interest not to give sex short shrift by letting it become too goal oriented.
Second, the missionary position is the best one to use when you are trying to conceive. Any other time, you should of course use whatever position(s) you enjoy. But right now, you need to be a little more task oriented, and your immediate task is to get those sperm just as far along their journey as you can. The missionary position allows for penetration closest to the cervix.
Case Study: Cherie
Cherie had been trying to get pregnant for six years when she finally came to Manhattan to see me (Sami). During the part of the intake interview where I ask about sexual positions, she looked as if she thought I was getting a bit too personal, but she told me that when she and her husband had sex, she was always on top. I ran a postcoital test (see page 197) that very day, and it showed no sperm swimming around. I didn’t find any other red flags, so I sent Cherie home with the recommendation that she and her husband switch to the missionary position for the time being. They did, and when Cherie came back for another postcoital test, sure enough, there were sperm. Within a couple of months, Cherie was pregnant, with no other intervention.
In addition, this may not be the best time for anal penetration. Obviously, that’s not going to lead to conception, but until you are pregnant, you might want to abstain even during the times in your cycle when you know you’re not likely to get pregnant. That’s because you could be facilitating the transfer of bacteria into the vagina and/or the urethra, which might lead to an infection that could threaten fertility. (See chapter 16 for more about infections.)
Case Study: Thea and Bobi (Sami)
once saw a couple who both tested positive for Streptococcus fecalis in their re-productive tracts, though the only symptom it was causing was the inability to get pregnant. Both Thea and Bob took antibiotics, and their infections cleared up. But still no pregnancy occured. So I retested them, only to discover that the strep was back. This went on through three rounds of antibiotics, until it finally occurred to me to ask them if they ever had anal intercourse. They told me they did. I explained that I thought that was the source of the recurring strep, prescribed antibiotics one more time, and never heard from them again. Months later, a new patient called to schedule an appointment, saying that Thea had referred her to me. “Oh, and how is she?” I asked. “Pregnant!” the woman reported. And, I presumed,.
After sex, stay put for ten to twenty minutes—especially if you’re the woman. (Though wouldn’t this be a nice time to cuddle for both of you?) I (Jill) once had a patient, a yoga devotee, who used to stand on her head after intercourse to maximize the effects of gravity. This is not necessary. Just don’t make the sperm fight gravity along with everything else. You may also have heard that the woman should lie with her legs up a wall. That’s certainly not going to hurt anything, but it isn’t necessary either. Just stay lying down. If you’re one of those women just dying for a pee after you’ve had sex, please don’t withhold urine so long that you give yourself a urinary tract infection. But you’ll be fine for fifteen minutes, if you can manage to hold it.
“Intimate Moisturizers”
Sexual lubricants (especially scented varieties) can interfere with conception. They are, in general, too acidic for the sperm to survive and swim well in. In addition, the concentration of salts in the lubricants can cause sperm to either shrink or swell beyond their capacity to perform normally.
If you need a little extra moisture—and many couples do at ovulation or under the stress of trying to conceive—you don’t have to do without. Look for Pre-Seed lubricant, which is specially designed for couples trying to conceive. It does not contain any glycerin or propylene glycol, the mischief makers in most lubricants. Its pH is the same as fertile cervical mucus, and it contains roughly the same amount of salts. It also has striations in it, little channels that ease the sperm’s movement, just as fertile cervical mucus does (though it lacks the nutrients that mucus also provides). A new Cleveland Clinic study of lubricants published in the journal Fertility and Sterility found that Pre-Seed was the only commercially available vaginal lubricant that didn’t decrease sperm motility or compromise sperm DNA.
Beware of some of the other common suggestions for lubrication, such as using a little warm water. Don’t! Water can kill sperm on contact. Or how about trying a little saliva? Wrong! Saliva contains digestive enzymes that stop sperm from swimming. Maybe you’ve heard that egg whites are a good lubricant. We don’t recommend them because of the risk of salmonella in raw eggs. (In addition, many patients who have tried it tell us it made them feel rather like an omelet!) Some doctors recommend mineral oil (sexual lubricants may contain it), but studies show that it may limit the ability of sperm to penetrate the egg. None of these effects is powerful enough to rely on as a birth control method, mind you, but when the idea is to get the sperm up to the egg, you do not want to make things any more difficult for them than they already are.
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