If you want to get pregnant, you might be wondering when the best time to have sex is, and how often you should have it to achieve a pregnancy.

Timing Sex

Your fertile window can be generally thought as a 6 day period, with the last day being ovulation. Your pregnancy chances increase when you have increased sex during this period, and it may result in pregnancy when it happens in the last 3 days of the window.

It’s important for you to know when you ovulate – and you may want to begin to think about finding this specific day before you start trying. First of all, you shouldn’t be relying on your period-tracking app to tell you when you ovulate. Instead, you should be paying attention to signs your body is sending you.

1. Cervical fluid
2. Cervical position
3. Basal body temperature

A study has shown that tracking your cervical fluid changes across your cycle, can predict ovulation as well or better than basal body temperature and LH strips.

What you’re basically looking for is egg white cervical fluid, that will give you a tip that ovulation is set to occur. Cervical mucus will increase 5-6 days before ovulation and will reach its peak 2-3 days before ovulation.

Sperm and Sex

If a man has normal sperm quality, having sex every day sperm concentration and motility will reman normal. A study also indicated that men with a low sperm count, sperm concentration and motility may be highest with daily ejaculation.

If you were to space out sex, and your partner is ejaculating every other day, this wouldn’t negatively impact his sperm parameters. However, if he’s ejaculating every 5 days, sperm parameters at this point may be affected. By 10 days without ejaculating, sperm parameters begin to deteriorate.

The bottom line is, as long as sperm parameters are normal (and you probably wouldn’t find this out until after getting tested by a fertility clinic), having sex every 1-2 days in your fertile window can be beneficial.

One study showed that having sex daily, led to a higher chance of becoming pregnant in the menstrual cycle.

Final Thoughts

It’s important to note that even if you’re having sex daily in your fertile window, this may not lead to a pregnancy – and it may have you worrying about infertility.

Fertility can be incredibly stressful and it can affect your self worth. Women spend so much time in their teens and twenties avoiding pregnancy, only to be consumed with it when they’re finally ready to start trying.

If you can’t talk to your partner or friends about this, there are certainly people you can talk to about to help you get you through this journey.

Furthermore, support also exists in helping improve your chances at pregnancy.

References

Optimizing natural fertility: a committee opinion. (2013). Fertility and Sterility, 100(3), pp.631-637.

In Canada, about 11.5 to 15.7% of couples experience infertility. After a certain period of time (1 year for people under 35, and 6 months for those 35 years or older), couples may choose to visit a fertility clinic to determine if there are any underlying issues keeping them from getting pregnant, and exploring what their options are.

Down below, I’ll be outlining the most common types of ART.

Ovulation Induction

Around ovulation, your body should be releasing an egg to be fertilized. However, if no egg is being released, this would lead to anovulation (which is the most common cause of infertility).

Ovulation induction uses certain medications to induce ovulation and lead to the release of an egg. These medications may include:

• Gonadotropins (synthetic FSH or LH, GnRH agonist, GnRH antagonist)
• Letrozole
• Clomid citrate
• hCG

Intrauterine Insemination (IUI)

IUI is a type of ART that inserts concentrated sperm (from a partner or donor) into a woman’s uterus (bypassing the cervix) around ovulation.

Cycle monitoring would be performed to determine when ovulation is happening.

This can be either a ‘natural’ cycle where no medications are used. Or, it can be a medicated cycle where there’s ovulation induction and/or a trigger shot.

Implantation will usually happen between 5-10 days later.

Who would benefit from IUI?

• Anyone with unexplained subfertility
• Male factor subfertility (ie. low sperm count, retrograde ejaculation, erectile dysfunction)
• Cervical factors (ie. mucus or cervical hostility)
• Endometriosis
• Couples with sexual dysfunction

Who would not benefit from IUI?

• Cervical issue (ie. blocked/narrow opening of the cervix, infections)
• Blocked tubes
• Severe sperm abnormalities (<5mil motile sperm)
• Amenorrhea
• After 6 failed attempts

In Vitro Fertilization (IVF)

This is the most common ART cycle in Canada. It involves the egg being fertilized by sperm in a lab setting. Medications are used throughout the cycle to produce around 10-22 eggs. Cycle monitoring is performed to assess follicular and endometrial development. Ovulation is stimulated to control for timing. Egg retrieval usually happens 36 hours after a trigger shot.

When eggs are retrieved, they are fertilized with sperm. This can happen naturally or through intra cytoplasmic sperm injection (ICSI) where sperm is injected into a mature egg.

The fertilized eggs (now called embryos) are incubated until the transfer day (usually day 3 or 5 of embryo development), where they are transferred into the uterus.

After retrieval, medications like progesterone can be used to produce a more favourable environment for the embryos.

Who would benefit from IVF?

• Unexplained subfertility
• Age-related subfertilty (ie. decreased ovarian reserve)
• Tubal issues (ie. blocked or damaged tubes)
• Endometriosis
• Cervical isses
• Uterine issues
• Hormone disorders
• Male factor infertility

Frozen Embryo Transfer (FET)

FET occurs when previously frozen embryos are thawed and transferred into the uterus. These embryos are usually prepared during a previous IVF cycle where there may be a surplus of embryos, if there were any complications or findings in a past IVF cycle, or simply for preserving fertility.

Implantation usually happens 2-5 days after the transfer.

Next Steps

Naturopathic Medicine can certainly play a huge role in combination with infertility. Particularly when we understand that it takes about 100 days for eggs to mature (that’s 3 menstrual cycles!).

Studies have shown that couple going through IVF specifically, are more successful if they are addressing their health prior to ART.

Things that I like to pay attention to, before and during IVF, are:

• Nutritional support for mom and embryo
• Supporting mitochondrial function
• Supporting ovarian health
• Protecting against oxidative stress
• Decreasing inflammation
• Managing and decreasing physical and emotional stress
• Supporting the immune system

For more information on how Naturopathic Medicine can support you during your ART journey, I encourage you to book a free 15 minute consult with me.

When you first start working with a fertility clinic, cycle monitoring is done as it determines when you’re ovulating so your fertility doctor can figure out the best time for insemination or have sex – to ultimately increase your chance of a pregnancy.

Cycle monitoring is done for:

• Natural cycles
• IUI, where ovulation timing is determined
• IVF, to measure the number and size of the follicles
• Donor cycles, where uterine lining is determined in the recipient

Monitoring is typically done in the mornings to get the best glimpse of your hormones, and to determine how you are responding to any drugs you may be taking.

When does cycle monitoring start?

Cycle monitoring takes place in the first half of your menstrual cycle. It begins when you start your period, and are experiencing substantial flow, not spotting. You will usually need to visit your fertility clinic around days 2-4 of your period where blood testing and ultrasounds will be done.

What does cycle monitoring monitor?

Blood work measures estrogen levels, a hormone that’s necessary for follicular growth as well as development of the uterine lining. Your ovarian reserve is also measured because your doctor will be looking for 6 to 10 follicles that will continue to grow in the next few days.

Ultrasounds are also done to visualize the progressive growth of the follicles and lining. Right before ovulation happens, a dominant follicle should be about 20 to 24mm in diameter. This, along with hormones (estrogen and LH), will indicate that ovulation will happen.

What happens after ovulation?

At ovulation, the dominant follicle is released, and is basically waiting for sperm to fertilize it. Your doctor may give you a trigger shot of hCG to facilitate ovulation.

At this point, you will be told to have sex or an insemination is done once (or twice) to fertilize your egg.

Depending on the type of cycle you have, you might go back to the clinic in the luteal phase to measure your progesterone levels, or and ultimately determine if you are pregnant.

Final Thoughts

Cycle monitoring can be particularly stressful because of the frequency of visits, as well as feeling anxious about how your hormones and follicles are doing.

Because you have a lot on the line – time, money, hope, there’s a desire to get everything right. Do the best you possibly can to get the outcomes you want. Expanding your health team, potentially including a naturopathic doctor, may support and enhance these treatments.