January 24, 2018

The best timing for making babies

OK, so you have decided you want to have a baby. Perhaps this means you are going to stop taking those birth-control pills that you’ve been on since your wedding day. Or perhaps it means you and your husband will simply stop using condoms. Or for some of you, who have been less diligent about birth control, perhaps it simply means no longer “pulling out” or no longer avoiding your supposedly fertile days, whatever you think those days may be. Your mind is innocent and worry-free. You are expecting that you will get pregnant so easily. You had no suspicion that you would ever find yourself hurled one year later into a world of taking your daily temperature and peeing on ovulation sticks. You never expected the day when 90% of your web activity is related to researching infertility. You never imagined a time when your every waking thought centers around why you’re not getting pregnant.

In the very early stages of this transition from happy-go-lucky to the fertility-obsessed, as you first become acutely aware of all your friends and neighbors and every woman at the supermarket being pregnant while you are not, what is the first question that takes shape in your mind? I’ll give you a hint. It is NOT “Why do all their husbands have good sperm and mine doesn’t?” or “Why are their Fallopian tubes so efficient and mine are not?” Nope. The first question that comes to mind for most women is “Why is everyone else having sex at the correct time and we are not?”

As human beings, our brains are quick to attribute a cause, whether real or imagined, to things that we don’t understand. In medicine, you see it all the time. For example, as a medical student, I remember a young man who came to the emergency room with a complaint of feeling sick, bleeding from the nose and having trouble breathing. Eventually, the workup revealed that he had leukemia. After the initial shock, his first question was “You know? Six months ago, I was in Mexico and I got really sick after eating some bad food. Do you think that’s what caused this?”

We see it all the time when counseling patients after a failed IUI or failed IVF cycle. They are quick to come up with a lot of potential explanations. “I was one hour late with my injections one day. Do you think that’s why it didn’t work?” “I noticed you said that my lining was only 8mm. I was talking to your other patient in the waiting room and she got pregnant with a 10mm lining. Do you think my lining is the reason I’m not pregnant?” “I heard that Brand X fertility medicine is better and I took Brand Y. Do you think that’s why the cycle failed?”

As women first begin to suspect they have a fertility problem, often their first inclination is to blame it on their not having sex at the correct time. Witness the booming industry of home ovulation tests, books that teach you to obsess about your mucus or websites with software for tracking your temperature. So, is poor timing truly the culprit for most infertility? No. No. No. With a mixture of common sense and looking at published reports, we can better get at the truth.

The truth is this: If you can have sex at a reasonable frequency (every 2-3 days) then just do it and completely forget about timing it. However, if you can only have sex once or twice a month, due to your schedules or for whatever reasons, then it’s very helpful to time it. A lot of couples make the mistake of obsessing about timing, when they already have sex frequently anyway. By trying to time things, they actually wind up having LESS sex than they normally would, thereby potentially reducing their fertility.

When can a woman get pregnant? In theory, the six-day period prior to ovulation is all a potential time for conception. To fine-tune it further, the two or three-day period prior to ovulation is the window period of highest fertility. Therefore, the BEST STRATEGY is to have sex every day. But doesn’t that result in depleted sperm? No. Contrary to myth, for men with good sperm counts, there is no significant depletion of the sperm parameters of count nor motility, even with daily ejaculation. I know this is counterintuitive, but research confirms it. Furthermore, there is even evidence suggesting that men with BAD sperm counts don’t even suffer a significant drop in these parameters neither. My own personal observations looking at samples from couples who do double IUI’s on back-to-back days confirms these findings. Most of the time, the second sample is better, equal to or just slightly worse than the first. Only rarely is it significantly worse.

OK, so what if daily sex is not practical for you? First of all, don’t feel bad. I can tell you from working with hundreds of married couples that daily sex is not the norm. Fortunately, a strategy of aiming for every 1 to 3 days is more than sufficient. By doing this, you absolutely ensure yourself of getting together during the 3-day window period. With the exception of ultrasound, all methods of trying to predict ovulation (temperature, ovulation kits, mucus checks, calendars) have inherent flaws and are not able to be 100% accurate.

So then you might ask, of what possible value is it to chart temperature, check mucus and do ovulation testing? Well, for most people it is of zero value. There is no research that suggests any benefit of all this diligent tracking over simply having sex every 1-3 days. But again, if you are unable to consistently have sex every 1-3 days, then charting or being aware of mucus can help you focus the general window period during which you should concentrate your frequency of intercourse. Just don’t obsess about predicting the one EXACT day of ovulation.

Having said all this, in my opinion, there are still two more possible ways that charting and timing might be of some benefit.

  1. If you find it stress-relieving to be more in-control, then charting and timing might be of help in relaxing you. You are not doing anything to boost your chances of conception by timing things, but you might feel less anxious if you feel more in-control, and that could have positive benefits.
  2. If charting and checking for ovulation results in clues telling you that you are NOT ovulating, then you will be alerted to seek medical help sooner than later.

So in conclusion, rather than obsessing about the proper timing of intercourse, just go for a sexual frequency of every 1-3 days and forget about the charting and the fertility awareness. Any questions?

  • Omitola Dionne Alleyne

    I need yr help