Optimizing natural fertility
Do you have questions on how to maximize your chances at conceiving, and you don’t have time to wade through all the information on the internet? Here we have boiled the information down to the most key points. The following guidelines are supported by the American Society for Reproductive Medicine (ASRM).
What is the optimal timing of intercourse and coital frequency?
You may have a smart phone application to help you time intercourse during the fertile window. These are great to use, but you just need to understand the length of your own cycle for them to be accurate. The fertile window is approximately six days long and includes the five days prior to ovulation, plus the day of ovulation. The highest probability of conception occurs when intercourse occurs 1-2 days prior to ovulation.
How do I know when I ovulate?
- Home ovulation predictor kits. While there are many options for monitoring ovulation, the most convenient yet effective way is to utilize home ovulation predictor kits such as “Clear blue easy.”
- These measure the LH surge and may help you decrease the time it takes to become pregnant, especially if you have intercourse less frequently or have irregular cycles (such as patients with PCOS).
- Kits typically demonstrate a “positive” result 1-2 days prior to ovulation, giving you advanced knowledge for timing intercourse.
- Monitoring cervical mucus. To monitor ovulation on your own and cost-free, you can track changes in their cervical mucus. The volume of cervical mucus increases with estrogen levels (coinciding with egg-readiness) and peak fertility is highest when mucus is slippery and clear.
- Temperature tracking. To be accurate this must be done immediately upon wakening, prior to any activity, and may be difficult for some patients to track. Remember that your temperature will change AFTER ovulation, and your most fertile period is PRIOR to and the day of ovulation. Therefore tracking your temperature provides reassurance that you did indeed ovulate — however, it will not let you know ahead of time when to time intercourse.
How often should we time intercourse?
- The highest pregnancy rates occur in couples who have intercourse every 1-2 days.
- Remember that it is not essential to have intercourse every day — or even on one specific day! This just adds to your stress level. You have a “window” of fertile time.
- A common misconception is that frequent ejaculations decrease male fertility. Frequent ejaculations do not generally affect fertility but > 5 days may have a negative affect.
Do sexual position and female orgasm affect pregnancy rates?
There is also no evidence between timing of intercourse and infant gender.
Do vaginal lubricants affect fertility?
Yes. Some may decrease fertility by decreasing sperm motility.
- Water-based lubricants (KY Jelly, Astroglide, and Touch)
- Olive oil
- Mineral oil
- Canola oil
- Pre-Seed (hydroxyethylcellulose-base)
Does BMI affect fertility?
Yes. If you are underweight OR obese, you are at risk of ovulatory dysfunction and sub-fertility.
Your ideal BMI is >19 or <35. Talk to your NRM physician if you are outside of this range to create strategies to move into your goal range.
In obese women, studies show that both nonsurgical (such as diet and exercise) and surgical (gastric banding or bypass procedures) weight loss can improve the frequency of ovulation and increase your likelihood of pregnancy.
Does Alcohol affect fertility?
Not likely when used in moderation.
- Moderate alcohol consumption <2 drinks/day for women attempting conception has not been demonstrated to have a significant effect on fertility.
- Several studies demonstrate a trend toward higher alcohol consumption and decreased conception, but other studies have found no relationship between alcohol consumption and difficulty conceiving.
- Certainly, abstinence from alcohol is recommended from the time of ovulation through pregnancy, because a safe level of prenatal alcohol consumption has not been established.
What about smoking?
- The prevalence of infertility is higher and the time to conception is increased in smokers.
- The association is strongest in women smoking more than 20 cigarettes per day, but a trend can be seen for all levels of smoking.
- Both smoking and use of smokeless tobacco have a dose-dependent effects on sperm function.
- Second-hand smoke exposure also has a negative effect.
- Smoking has also been associated with accelerated loss in female reproductive function (aging of the ovaries) and earlier age at menopause by 1 to 4 years!
Smoking also has significant effects on early pregnancy:
- Increased risk of ectopic pregnancy
- Increased risk of miscarriage
Possibly at higher intake levels.
- Moderate levels of caffeine consumption likely do not affect fertility or pregnancy outcomes. The physicians at NRM recommend you look online for the caffeine content in your beverage of choice to determine if your consumption is indeed “moderate” — those vente Starbucks beverages may surprise you!
- High-levels of caffeine >500mg/day have been associated with decreased fertility, and >200-300 with increased risk of miscarriage, although these studies are not definitive.
- Overall, it is reasonable to limit your caffeine use while attempting to conceive to less than 200 to 300 mg per day.
What is a “normal” expectation regarding time to conception?
- Approximately 80% of couples will conceive by 6 months and 85% will conceive by 12 months.
- Half of remaining couples will conceive spontaneously in the subsequent 3 years.
Wondering when or if you should consult with a physician?
Infertility is defined by ASRM as the failure to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse or exposure to sperm, or after 6 months if the female partner is >35 years of age. If you have known tubal or male factor problems, or are not having regular menstrual cycles, don’t wait — call us today.