When you’re trying to get pregnant, every practice gets scrutinized (and many times, ritualized). And like other subjects in the fertility sphere, it may feel confusing and overwhelming. This quickly leads to a common reaction: trying to be as ‘scientific’ as possible about the best time to have sex to get pregnant each month. I’m of course a proponent of empowerment through knowledge. But what I frequently encounter is a couple who is stressed. The woman is stressed by trying to figure out when she’s ovulating and the man is stressed about the pressure of a positive ovulation stick. Read on to find best timing to conceive, how it doesn’t matter as much as is thought, and other ways to optimize pregnancy each month.
The stats on getting pregnant.
- The very highest chance of conception is typically in the 1st few months of trying.
- But don’t worry if you’re past this timeframe, because about 80% of couples will get pregnant in the 1st 6 months.
- Approximately 85% couples will be pregnant after trying for a year.
- This can be further stratified by a woman’s age (due to decreasing egg number and quality): time-to-pregnancy studies show about 87-88% of women <35 years and about 72-73% of those 35 and over.
- This is in bold because the above statements can feel scary: about 95% of couples will be pregnant with 2 years of trying. That is the vast majority! Please have hope.
So, how often should we be doing it?
- Sperm survive in the reproductive tract for 3 days on average, but can survive up to 5 days.
- Studies show that even daily ejaculations have no detrimental impact on sperm movement or count in men with normal sperm quality.
- Even in men who have lower sperm concentration, intercourse every 1-2 days may help their motility and count.
- In fact, abstinence for too long may be detrimental.
- Intervals of greater than 10 days can hurt sperm shape.
- Intervals greater than 5-7 days may hurt sperm counts.
In sum, having intercourse at different frequencies won’t hurt the sperm parameters, unless there is abstinence for more than a week or so. Having sex each day vs every 3rd day seems equivalent to sperm quality; see below for timing!
When in my cycle should I have sex to get pregnant?
- The right answer is very much dependent on you two! For some couples, weekly intercourse is very stressful. For others, it is stressful not to have sex daily.
- Couples who have sex infrequently should use fertility awareness biomarkers to optimize timing of ovulation to give the best chance of getting pregnant.
- Otherwise, intercourse every 1-3 days is fine.
- Studies show the best timing of sex to get pregnant is during the fertile window.
- 6 days, ending on day of ovulation
- The 2 days before ovulation and then the day of ovulation represents the peak time to have sex and get pregnant, even within this window.
- After ovulation happens, the hormone changes and progesterone rise make it harder to conceive.
- There’s a window of implantation within the lining of the uterus that ‘closes’ after exposure to prolonged progesterone.
- The cervical mucus becomes impenetrable to sperm after progesterone rise.
How do I know when I’m ovulating?
- Here is a great article describing different fertility awareness biomarkers.
- Cervical mucus is an accurate tool to determine ovulation and timing of intercourse.
- Once it becomes slippery, clear (“egg white”), we believe ovulation will be occurring typically within a few days.
- Ovulation predictor kits
- Ovulation will occur within a couple of days after a peak result.
- Take caution in that up to 35% of the time it may read negative even though you are ovulating, due to different reasons.
- Basal body temperature
- This relies on progesterone causing a rise in your body temperature.
- It’s not good for predicting intercourse timing because it only goes up after ovulation has occurred.
- Pelvic ultrasound
- A thorough look at the reproductive organs and where you are in your cycle, but not as easy because it requires doctor’s visits.
- Blood hormone testing
- This provides more insight but isn’t as easily accessible or practical for most cycles.
Do I need to be doing a handstand afterwards?
- In short, no. The vagina is beautifully designed — it naturally forms a slide of sorts, with the bottom near your cervix. So when semen is deposited in the vagina, the sperm get a red carpet right to the entrance of the womb.
- It’s completely normal to have semen come out afterwards. Semen is typically 2+ mL in volume, so it is noticeable. I think of it as the ‘car’ that gets the sperm riding inside where they need to be. Pretty much all of the sperm that are moving forward will be able to get into the cervix and from there, the uterus and tubes.
- In fact, interesting studies show that there are sperm in the tubes within minutes of ejaculation and in the cervix within seconds.
- I also think of the egg / dominant follicle as sending a bat signal of sorts: other studies show that the sperm travel to the side the maturing egg is on!
- However, as I tell my patients, so much of fertility is a mental game. It certainly won’t hurt to lay down for 15 minutes after ejaculation. But it’s equally fine to get up right afterwards.
- The type of lubricant may matter, at least in the petri dish.
- Research examining different types show that common ones (many name brand marketed lubricants, olive oil, even saliva) may have a detrimental effect to sperm movement.
- But it also shows that canola oil and hyxdroxycellulose-based lubricants don’t appear to negatively impact the sperm.
- My caveat is to always use lubricant if needed to minimize discomfort!
I hope this helps clarify that there aren’t too strict of rules about intercourse! The most important is to decrease your stress surrounding it, know that variable intercourse timing typically won’t significantly affect your chances, pay attention to your body’s natural cues to determine when ovulation (and the best chance of pregnancy) is happening, and enjoy the unitive act of making love with your partner (and try to ignore the ovulation sticks at least once in a while).
I am a USC-trained Reproductive Endocrinology & Infertility physician with a boutique practice in Orange County, CA. I am also a Fellow in Integrative Medicine at the Andrew Weil Center at the University of Arizona, a FEMM Fellow at the Reproductive Health Research Institute, and serve as Associate Clinical Faculty at UC Irvine. My goal is to radically reimagine my field by focusing on whole body methods to identify the root cause and heal reproductive issues, like fertility, miscarriage, and abnormal cycles. I do this through integrative medicine practices coupled with traditional REI techniques, all while avoiding aggressive procedures. I’m grateful to have been selected for multiple years running as a Southern California Super Doctor and Rising Star, Orange County Physician of Excellence, and Top Doc in Pasadena. I am a Healthcare Task Force member for Life Perspectives, a leader in education, research, expertise and support after reproductive loss; serve on the Advisory Board for Pre-Health Shadowing, a non-profit that makes discovery of different medical specialties accessible to students; and have been an invited guest at multiple conferences and podcasts as well as an author of book chapters and multiple articles. I am excited to use an integrative medicine lens to educate about women’s issues!