Wednesday, January 30, 2008

SEX! and other FAQs

A former patient with a particularly wry sense of humor has observed that this blog is a bit dry. I can’t help it – when patients see me in the office, I try to inject a little humor into the visit in order to put them at ease (you must admit that some aspects of infertility treatment can be funny), but it’s hard to be light-hearted when putting things down on paper (or rather, on a screen) for everyone to see.

There is something to be said for a sense of humor. It’s a coping mechanism of sorts, kind of like prayer or meditation. It worked for my patient, anyway, and we enjoy her periodic visits to show off her baby. JT, this blog is dedicated to you.

Q: How often should I have sex if I’m trying to get pregnant?

MPS: It’s the number-one question of infertile patients, and I’m amazed at how much misinformation there is about it. First of all, NO ONE HAS EVER SHOWN THAT HAVING TOO MUCH SEX WILL DECREASE YOUR CHANCES OF CONCEIVING, assuming that we are dealing with intercourse that ends with ejaculation into the vagina. Yes, I know semen quality declines with frequent ejaculation, but hey, those sperm are going where they need to go. In more than 20 years of practice, I have never seen a couple who presented with infertility due to having too much sex – I challenge you to find such a case. If you want to do it every day, be my guest. However, anything more than about three times a week is for recreational purposes only. Sperm survive in the female genital tract about 2 or 3 days near the time of ovulation, so more than every other day will not improve your chance of pregnancy. Now, if you look around in the medical literature, you can find papers that show increased pregnancy rates with more frequent intercourse, up to five times a week, but those investigators didn’t account for the fact that younger couples are more likely to have sex, and are more likely to get pregnant as well. When you control for age, maximal fertility tops out at about three times a week. I tell patients that if you having 28-day cycles you should have sex at least three times a week between days 10 and 20. I think that doing it every other day is bit too regimented, but some people find that schedule helps them stay focused.

Often, infertile couples are burned out on sex by the time they see me. They work hard, they are tired when they get home, and they’re sick of doing it like bunnies month after month. I think if you want to pick the ONE DAY to have sex the entire month, use an ovulation prediction kit, and have sex the night the kit turns positive. You can achieve success almost as good as with the three-times-a-week regimen if you do it that way. (See below for more info about ovulation predictor kits.)

Q: Someone told me I should elevate my hips on a pillow after sex. Will this help me get pregnant?

MPS: If pillows were required for reproduction, our species would have long since died out. I am not aware of any study showing improved pregnancy rates with post-coital hip elevation. Here’s what I recommend: after sex, lie there for five minutes or so, then get up and go to the bathroom to empty your bladder (this is good hygiene for preventing bladder infections). Yes, fluid is going to leak out, but that’s ok.

Q: What kind of ovulation prediction kit should I use?

MPS: Several years ago, Consumer Reports did a study on ovulation prediction kits. I was impressed at how much difference in quality there was among the brands out there. The winner in that evaluation was a product called Clearblue Easy (it used to be called Clearplan Easy), and a newer version called Clearblue Easy Digital is even better – that’s the one I recommend. (By the way, I have no financial interest in this product.) We use these kits to time artificial inseminations and post-coital tests, and they work quite well.

Most ovulation predictor kits detect a surge of luteinizing hormone (LH) in the urine. This is the hormonal trigger that tells the ovary to release the egg. However, there are some other products out there that claim to predict ovulation by detecting changes in saliva, vaginal discharge, or sweat. One product even claims a 65% improvement over urine LH kits, but in my opinion, no one has ever shown these products to be as good as a quality LH kit, and I don’t recommend them.