• Optimizing Fertility; Facts and Myths

    by Renee Cotter, MD
    on Oct 17th, 2017

For women who are looking to start a family or add to their existing one, optimizing fertility is a top priority. A recent article published in the American Society for Reproductive Medicine discussed some very interesting and, oftentimes, surprising new information regarding fertility. The article dispels certain widely accepted myths and even brings up new advice, from the effect of different lubricants and diet to rituals during sex. After such a long break, we want to start off our blogs again by divulging this brand new research to offer some incredible new insight on the best ways for your and your partner to become pregnant.


Fertility

First of all, let’s define fertility and infertility. Fertility is the natural ability to have a child whereas infertility is the inability to become pregnant after at least 12 months of unprotected intercourse/sperm exposure. For women over 35, however, infertility can be diagnosed after just 6 months without becoming pregnant. Normally, four out of five women typically become pregnant within six months of trying. Interestingly, your first three months of exposure to sperm is the time where your fertility is highest, with fertility gradually declining after this. Within each monthly cycle, there is also the fertile window: the 6 days leading up to ovulation with the 6th and final day on the day of ovulation. Within this fertile window, the last three days ending on ovulation is the time period which is most likely to result in pregnancy. Knowing this, you can be more aware that sex in the few days leading up to ovulation is the most important time if you’re trying to become pregnant. If you can time this well in your first three months of trying, you could take hold of the maximum chances to become pregnant. Think three: threedays until ovulation and the first three months of unprotected intercourse.


Age

I’m sure that as a woman, you are well aware of the ticking clock analogy that many like to compare us to. Of the factors that affect fertility, the most well known and discussed is surely age. While many of us would like to turn a blind eye to this knowledge, it is, however, a real factor that negatively affects our ability to become pregnant. Both men and women see a decline in natural fertility as we age, however age affects women more strongly than men. For women, a steep drop in fertility happens after age 35 but for men, this doesn’t occur until they are 50 years old. Not only does becoming pregnant become more difficult, but your risk of birth defects also drastically increases. At 35 years old, you are 2.6 times more likely to have a baby with birth defects compared to at age 20 and nearly twice as likely (1.92 times) compared to age 30.


Intercourse Frequency

This article uncovered some new and very surprising information regarding how often you and your partner have sex. Before, it was generally thought that sex at least one per week but not more than every other day was the best recommendation to achieve pregnancy. The idea was that sperm count or quality would decline with too frequent ejaculations and thus many recommended against daily intercourse. This new article completely dismisses former notions and actually found that daily sex was associated with the highest ability to get pregnant. In second place came intercourse on alternating days. With sex occurring just once a week, the chances of becoming pregnant dropped to just 15% compared to the 37% associated with daily intercourse. For very sexually active couples this is very good news; however, no one should let this recommendation cause any undue stress in their relationship. It is very important to consider your own preferences and life in regards to this recommendation and not to overly stress yourself and your partner to rigorously fit into daily sex if it simply isn’t for you. Extra stress due to forced intercourse would not be optimal for conception either so always make sure that you are making whatever decision is healthiest for you.


Fertility Monitoring

Fertility monitoring is a very popular method for couples trying to become pregnant. When you visit any pharmacy or go online, you are likely to find recommendations for ways to monitor or track your fertility. There are kits, apps, or simple self observation. This article, however, states that monitoring your cervical mucus, libido, pain, or mood is only accurate in predicting fertility 50% of the time. Furthermore, even in women who have regular cycles, the time of peak fertility varies widely. This makes it very difficult to tell when the best time for you to become pregnant would be. How can you track your fertility if many of the common methods are reliable only half the time? Of the common methods to track fertility, measuring cervical mucus is only of the only good and reliable methods. This article found that simply measuring your cervical mucus is more accurate than a menstrual calendar and does as well as or better than measuring body temperature or urinary hormones.


So how do you do this at home? I recommend keeping a diary or a calendar where you observe your discharge. On each calendar day, write down notes about the type of discharge you are having, be it dry, sticky and white, or gooey and clear. The gooey and clear discharge, which I like to compare to an egg white, is the sure sign of approaching ovulation. When your discharge is at it’s gooeyest and clearest, this is the day of ovulation and the also the day with the highest chances of conceiving. Knowing this and the other factors we talked about earlier, you can time intercourse to occur on the days leading up to an on the days of your ovulatory discharge. By keeping a diary or calendar of your discharge changes, you can become more in tune with your body and also start to predict when this discharge will appear each month.


During Sex

Many other common fertility beliefs surround practices during and after sex. For example, many women remain lying down after intercourse to ensure that sperm remains inside them, however, this belief has not been scientifically proven to work. Within seconds after ejaculation, sperm can be found in the entrance to the uterus no matter what position you are in. Sperm then makes its way to the fallopian tubes in as little as 2 minutes and up to 15 minutes depending on the time of your cycle. This time is actually shorter the closer you get to ovulation. Isn’t that fascinating? Interestingly, sperm are even able to travel to the correct fallopian tube that connects to the ovulating ovary, and ignore the non ovulating ovary. You can really rely on those little swimmers to do their job. Another disproven myth is that there is no evidence that shows that certain practices, positions, etc. during or after sex affect infant gender.


Lubricants

Another target of the study was different lubricants. Common water-based lubricants such as Astroglide, K-Y Jelly, K-Y touch and other lubricants like olive oil and saliva restrict the ability for sperm to move. Knowing this, it’s best to use a lubricant that doesn’t affect sperm. Mineral oil, canola oil, or lubricants made with a compound called hydroxyeethylcellulose are recommended for couples who are trying to become pregnant.


Diet and Lifestyle

Living in California, I’m sure that many of us are aware of the common diet and lifestyle trends floating around. Several eating habits claim to strongly affect fertility. You’ll commonly read that you should avoid alcohol, caffeine, processed foods, red meats, and more. But are these actually valid? Well, as it turns out, for some of these, not really. While extremes in weight are known to negatively affect fertility (obesity doubles conception time and anorexia quadruples it), diet variations like vegetarian, low-fat, paleo, etc. do not affect fertility or infant gender at all. The only dietary factor seen to negatively affect fertility is consuming lots of seafood due to the large amounts of mercury. Eating moderate amounts of seafood or choosing fish low in mercury (Salmon, trout, shrimp, squid, anchovy, sardines, etc.) are good choices if you are trying to conceive.


For alcohol, several studies claim that it decreases fertility while others claim that it actually increases fertility. Because of the large amount of evidence, there is no clear guideline for alcohol before becoming pregnant. Similarly, while the effect of caffeine consumption on fertility is not clear and some studies suggest that drinking more than 5 cups of coffee per day decreases fertility, there are no negative affects from 1 to 2 cups of coffee per day. This is a plus for those of us who like to enjoy our morning cup of coffee without added stress or guilt.


Smoking cigarettes and marijuana are two lifestyle factors that do negative effect on fertility. Smoking cigarettes increases the risk of infertility by 60% and marijuana increases it by 70%. The study also discussed how certain toxins in our environment might affect fertility like those in dry cleaning, printing, heavy metal work, industrial microwaves, and pesticides. If possible, it’s best to generally avoid these.


Conclusion

Overall, this article touched on many subjects in regards to fertility and brought some new and surprising information to light. The frequency of intercourse, use of lubricants, and the efficacy of fertility monitoring are some of the notable topics in this article. Here are some of the most important things to remember:



Hopefully with this new knowledge, doctors everywhere will help women with the knowledge they need to successfully become pregnant when they want.

Author Renee Cotter, MD

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