Frequency
"Here’s one good way to get pregnant: have lots of sex."
Forgive us if it seems we are stating the obvious, but we think it bears repeating. We’ve both had plenty of patients focused like lasers on the exact day of the woman’s cycle when they should have sex to conceive, having sex on that day and maybe one day just before that as well, and then not having sex for the rest of the month. And we’ve had lots of patients who’d read on the Internet all about letting sperm build back up between ejaculations and were limiting sex in some kind of rationing effort.
Unless the male partner has been diagnosed with a low sperm count or low semen volume, you can pretty much feel free to have all the sex you want. (It is a good idea to keep it to once a day.) Not only won’t it hurt anything, but it will greatly increase your chances of conceiving. (It could reduce stress levels a bit, too, if you do it right.) Of course, it’s fine if you’re not inclined to have sex every day, but every other day around ovulation is important. And if a postcoital test (see page 197), done twelve to eighteen hours after intercourse, shows dead sperm, you do need to have sex every day at mid-cycle to maximize your chances of conceiving.
Research has shown that couples who have sex about once a week have a 15 percent chance of conceiving in any given cycle, while those having sex every day kick up their chances to 50 percent. One study found that only 12 percent of couples reported having intercourse five times a week or more, but for those who did, there was no negative impact on fertility.
Another study, looking to advise couples in which the fertility issue had been traced back to the man on how long to abstain before collecting semen for ARTs, found that sperm and semen quality peaked between one and three days of abstinence, with significant decreases in quality as the period of abstinence stretched on. Although the sperm count went up, the older sperm started to deteriorate. Note that this was in men with a diagnosed fertility problem. But the study found that the official guideline most commonly followed, to go two to seven days without ejaculating before collecting sperm, did not serve the couples’ best interests. Men with no reason to maximize their sperm counts surely have even less reason to limit the amount of sex they have.
If you are working with a sperm count that’s low or low normal, you might want to keep ejaculation to every other day to give the count a chance to build up a bit, at least around the time of the woman’s peak fertility. But there’s no need to limit it any more than that, and in fact there seems to be a benefit to not abstaining any longer.
Case Study: Donna
For some people, it is possible to overdo it on sex. That’s what happened to Donna, who had consulted with a feng shui expert about her trouble getting pregnant some months before she met me (Jill). The feng shui expert advised placing a plant beside the bed and a bowl of water under the bed. Each time Donna and her husband had intercourse, they were to pour the water on the plant. If the plant thrived, they would conceive. Well, it wasn’t long before the plant was all but dead—from overwatering! And Donna still wasn’t pregnant. That’s when she came to see me. I found that in their eagerness to conceive, Donna and her husband were having too much sex, given his low–normal sperm count. With some good fertility counseling, focusing especially on how best to time intercourse, Donna was soon pregnant. (No word on the health of the plant!)
It’s All in the Timing
If you and your partner are healthy and have no particular fertility challenges, the single most important thing you can do to help this process along is to know when to have sex. Which is to say, you need to know when you ovulate and to time the swimming of the sperm accordingly.We’ll get to the particulars of how to predict ovulation in a minute. But once you know when you ovulate, the key is to have sex ahead of time. Once they’re in your body, the sperm will hang out for a bit, just swimming around, looking for something to do—just waiting for an egg to debut. The egg will not lollygag, so if you wait until you think it’s on the move, you have a very short window of time for the sperm to catch up to it. Having sex on the day ovulation is about to occur may be ideal, but better the day before than the day after, when it will be too late. Think of boarding a cruise ship. Sometimes you can board a couple of days before launch, but once it pulls away from the dock, you are out of luck. That ship has sailed, and you’re just going to have to wait for the next one.
Researchers at the National Institute of Environmental Health Sciences studied more than two hundred healthy women planning to get pregnant. They tracked their estimated ovulation and the days on which they had intercourse. Conception took place only when intercourse occurred in the six days leading up to ovulation, and the likelihood of conception increased dramatically the closer sex was to the actual day of ovulation. Only a small number of pregnancies were due to sperm that were three or more days old, and none occurred with sex after the day of ovulation.
Case Study: Lee Anne
Lee Anne, age 41, had been trying to get pregnant with a second child for a year. She’d had no trouble conceiving the first one. (This “secondary infertility” seems particularly baffling to doctors.) She and her husband had been diligently following her doctor’s advice to have sex on the eleventh, thirteenth, and fifteenth days of her cycle.
What the doctor hadn’t taken into account, however, was that although Lee Anne, like many women as they get older, had a regular menstrual cycle, it had become shorter than average, only about twenty-four days. So by the time she was at day 11, she had already ovulated. By having sex on the days recommended, she and her husband were sure not to conceive.
They were actually practicing the “rhythm method” form of birth control. My (Sami’s) advice to Lee Anne was simple: have sex fourteen days before you expect your period to start. Counting backward from your next period is a more reliable indicator of when ovulation will occur than counting forward from your last period. The number of days from ovulation to the start of the next period varies from woman to woman, but it is generally the same from month to month for an individual woman. It is also likely to stay near the average fourteen-day length, or at least in the eleven- to fourteen-day range.
By contrast, the number of days from the start of your period to ovulation is more likely to shift from cycle to cycle. It’s that first part of the cycle that accounts for longer or shorter than average cycles, as well as for irregular cycles. Once Lee Anne and her husband more productively timed when they had intercourse, she conceived promptly and had a lovely baby girl.
Sperm generally live for seventy-two hours—that’s three whole days—as long as they have good, alkaline cervical mucus to sustain them, and they can sometimes make it for up to seven days. An egg, meanwhile, is fertilizable for only twenty-four hours, and that time frame may squeeze down to just twelve hours as women get older. So your best bet is to have the sperm ready and waiting for the egg when it is released, and that means the best time to have sex is on days 12 through 14 of a standard twenty-eight-day cycle, where ovulation is on day 14. You’ll have to get to know your own cycle to get the timing exactly right, and just how to do that is coming up next.
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