In my treatment room, many women have come through the door sharing their frustration of being unable to fall pregnant naturally. Some women were in the middle of their fertility journey, and others were going through IVF. Of the women trying to fall pregnant naturally, some were unsure about certain facts and assumptions of natural conception. There appeared to be a common confusion around this, including when the best time to have sex was, and so this article discusses three main issues.
Timing is key
In some rare circumstances, a small percentage of the women I was treating for fertility were actually having unprotected sex at the wrong time. This was generally due to two key issues:
Their menstrual cycle didn't represent a typical 28-day period, so they were under the assumption that ovulation was on day 14 and was having sex up until that day. Ovulation generally occurs about 10-14 days before a menstrual bleed, meaning if a woman's cycle was 35 days, their ovulation range is actually between day 22 and 26. This means if they were having unprotected sex only on days 10-14, then they had sex 8 days too early. Unfortunately, sperm lives up to 5 days in the uterus, by which time when ovulation does occur, there is no sperm left to meet the egg.
Some women are under the assumption that the best time to have natural conception is on the day they ovulate. While this seems logical, this is not ideal for natural conception. The egg takes about 12-24 hours to travel from the egg to the fallopian tube, which is the general site of fertilisation. If conception occurs inside the uterus, generally a viable pregnancy does not take place. The ideal time to have unprotected intercourse is roughly 2-5 days before ovulation.
Not sure when you're ovulating? Click here to find out how to track ovulation.
Lubrication and fertile mucus
Fertile mucus, which is generally seen 3-5 days before ovulation, aids the process of natural conception. You may notice that your cervical/vaginal mucus discharge changes from thick, white to clear, viscous mucus. This is due to the changes in pH as well as hydration, which allows sperm to survive and move easier compared to non-fertile mucus. Some women may not have optimal fertile mucus and instead may opt for lubricants. However, be aware that not all lubrication products are sperm friendly. For example, a study showed that KY Jelly, a well-known lubricant, reduced sperm movement down to almost nothing after 60 minutes, making it the most harmful lubricant. Alternatively, Pre-Seed has been shown to be the most sperm friendly lubricant.
Frequency - How often is too often?
Some couples can get very enthusiastic about falling pregnant and report that they have unprotected sex every day. While I commend their eagerness and measured approach, daily ejaculation can be detrimental on the total sperm count. In one study, the semen volume was 70% higher, and sperm count was 50% higher when healthy men ejaculated every 2-3 days as opposed to every day.
In summary, there are a lot of factors to consider when falling pregnant naturally. Knowing when you are ovulating will help you to identify when your most fertile period is. The rule of thumb is to try to have unprotected sex every 2-3 days after your menstrual cycle finishes and use sperm friendly lubricant if needed. If you are unable to conceive after 6 months of having unprotected sex, please visit your general practitioner.
Amann RP. Considerations in Evaluating Human Spermatogenesis on the Basis of Total Sperm per Ejaculate. Journal of Andrology. 2013; 30: 626-641
Sakkas D, Ramalingam M, Garrido N, Barratt CLR. Sperm Selection in Natural Conception: What Can We Learn From Mother Nature to Improve Assisted Reproduction Outcomes? Human Reproduction Update. 2015; 21:711-726
Sandhu RS, Wong TH, Kling CA, Chohan KR. In Vitro Effects of Coital Lubricants and Synthetic and Natural Oils on Sperm Motility. Fertility and Sterility. 2014; 101: 941-944