Scientific Evidence on How Much Sex to Have when Trying to Conceive

Have we ever, in the history of humankind, been more confused on what is healthy or not to eat? Eat low fat, nope never mind, eat healthy fats. Avoid eggs, just kidding, they are super healthy. Let’s not get started on wheat.

 

We are not here to talk about food, however, but sex. But just like food, there has been some back and forth on what is right, creating some confusion about the frequency of intercourse. 

 

Similar to eating, there are some no-brainers. For example, food growing out of the ground that has not been sprayed with toxic chemicals is a healthier choice than a bar disguised as nutritious with ingredients that we can’t even pronounce and contains more sugar than a cupcake. The no-brainer for trying to conceive naturally is that you must be fertile, you must have sex and sex has to happen when you are fertile.

 

It starts to get confusing when trying to figure exactly when the fertile window is happening, if either or both partners may have infertility issues or not, and exactly how much sex to have in regards to sperm health.  Google 'sex frequency for trying to conceive' and you will see all sorts of advice. One article may say to have sex every other day, another will say to have sex 3 times a week. Wait no, here is one saying it's a myth to save up sperm and to have sex every single day.  Which advice is correct? Let's take a look at the research behind the claims. 


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The basis of storing sperm comes from studies showing that there is more sperm after abstinence. Sperm counts are maximized after about 5 days of abstinence, and therefore couples have been advised to abstain from intercourse before the fertile window and before a sperm analysis, especially if the man has low sperm count.  This would theoretically maximize the sperm count at the first act of intercourse during the fertile interval and throughout the rest of the interval.

 

It is true that sperm concentrations will drop with increasing frequency of intercourse but daily intercourse in the majority of men does not drop the count enough to reduce the added conception benefit of each act of daily intercourse (source).  In fact, studies show that while it's true that sperm count may go up with abstinence, sperm vitality overall goes down. Researchers found that by ejaculating within 1 to 4 hours and 24 hours again, total motile sperm count increased over and above that of the first ejaculate (source).

 

low-sperm-count

Turns out the belief is that men should ‘save up’ their sperm before the fertile window, even if they have low sperm count, may actually decrease the percent chance of conception. The studies mentioned conclude that daily ejaculation (or even twice daily) may overcome impaired sperm transport and may significantly increase the potential for conception in infertile men (source).  This conclusion still needs further studies on large populations to confirm the results, but it makes sense, doesn’t it? If you have intercourse twice in an hour, you increase the amount of sperm on their way to the egg. 

 

In general, research is showing that men should ejaculate between three and four times a week to ensure a proper amount of motile, normal sperm. Eliahu Levitas, a fertility specialist in the IVF unit of Israel’s Soroka University Medical Center, conducted a study to examine sperm samples from approximately 6,000 men, all of whom had abstained from intercourse for up to two weeks. About 75% of the men had normal sperm count and 25% had low sperm count, or less than 20m sperm per milliliter were being produced.

 

Similar to previous the previous research mentioned, the study discovered that with abstinence, the low sperm count group had a steady decrease in sperm motility throughout the course of a typical day of abstinence. Additionally, there were other changes occurring with regard to shape, a telltale sign that sperm were going stale. The men with normal sperm count? In this group, they demonstrated little change in motility following abstinence and didn’t show signs of staleness until much later (source). 

 

What if you have normal sperm count?  For those with regular sperm count, the current recommendation is to have intercourse on multiple days throughout the 6 days of the fertile window. This will raise the overall probability of conception, though not additively.  Daily intercourse during the fertile window is preferable to less frequent intercourse because each day of intercourse raises the probability of pregnancy (source). 

 

 "Our data challenge the role of abstinence in male infertility treatments and suggest that to present the best possible semen samples, patients with male factor infertility should collect the semen after just 1 day of sexual abstinence. Patients presenting normal sperm analysis or sperm donors for cryopreservation purposes should be advised not to exceed 10 days of sexual abstinence, " (source).

 

What about outside your fertile window? The best advice is to keep it spontaneous and romantic to avoid burn out. If you and your partner are not experiencing burn out, it’s good to have sex at least a couple times a week. The reason behind that is that there is some new research showing that women who are actively having intercourse may have a better chance of getting pregnant. This is due to the immune system changing to prepare for pregnancy (source)

 

The conclusion from all this data? Well, looks like science is still trying to work out the details, but from what the data reveals, sex every day or every other day during your fertile window is the way to go. If your partner has low sperm count you may want to talk to your doctor about trying the ‘twice in one hour’ method each day two days before you ovulate.

 

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If you and your partner are starting to feel like sex is a chore? You may consider taking a month or two off from trying. If that isn't what you want or are concerned about age-related fertility, your chances don’t go down much less if you have sex every other day during your fertile window. Outside your fertile window, you may try and aim for 2 times a week to keep both your bodies prime for fertility or at least no longer than 10 days.

 

In the end, the frequency is totally up to you and your partner, but at the very least, make sure you are having intercourse at least once before 24-48 hours before you ovulate. 

 

 

Additional References: 

Wilcox AJ, Weinberg CR, Baird DD. Timing of sexual intercourse in relation to ovulation. Effects on probability of conception, survival of the pregnancy, and sex of baby. N Engl J Med 1995;333:1517–21.

Dunson D, Baird D, Wilcox A, Weinberg C. Day-specific probabilities of clinical pregnancy based on two studies with imperfect measures of ovulation. Hum Reprod 1999; 14:1835–9.

Colombo B, Masarotto G. Daily fecundability: First results from a new database. Demographic Res 2000;3:5.