Fertility-Focused Intercourse: Does Timing Sex Improve Conception Rates? (Episode 563)

Full Transcript: Episode 563

Lisa Hendrickson-Jack:

This is the Fertility Friday Podcast, episode 563.

In today’s FAM research series, I am answering a really interesting question — and it may seem obvious, but I think it’s still worth covering. The question is: will getting the timing right help you get pregnant faster?

Now, I say that that may seem obvious because many of you who have listened to the podcast for a while and are familiar with fertility awareness techniques — it makes sense that timing would make a difference. But what about for couples who’ve been trying to conceive for a long time? I think that when I first started charting, I kind of thought you couldn’t screw it up, so to speak, if you were trying to conceive. I was using fertility awareness to avoid pregnancy for the first decade of my experience as a fertility awareness user. And in some ways you kind of think to yourself, well, because we’ve been brainwashed to think that we could get pregnant on every single day of our cycle, that you would just get pregnant if you were just having sex based on whatever you were thinking. But it turns out that there is something to this.

And the reason that I wanted to have this episode here — and I was really excited to find the research paper that I am going through today — is because this topic did come up in our FAM program. One of our FAM practitioners posted a question. Of course, in the FAM program, we are diving into not only timing, but we are also diving into strategies to support and optimize menstrual cycle health as well as fertility. And so the question is: does just addressing the timing only — does that increase a couple’s chances of conception? Or does there always have to be these other aspects of it?

So when you’re trying to conceive, it’s important to focus on both aspects. It’s important to focus on both timing and optimizing fertility, supporting sperm and egg quality. But that still brings us to today’s question of: will simply adjusting the timing to ensure that you’re hitting the right days for intercourse each cycle — will that alone increase the chances of pregnancy? The short answer is yes. And in today’s episode, we’re going through a study that examined this question in a lot of detail. So without further ado, let’s go ahead and jump right in.

So as always, if you are wanting to dive into the study and find more information, you can head over to fertilityfriday.com/563. And if you’re enjoying the FAM research series, you can head over to fertilityfriday.com/research and you’ll find the list of all of our research episodes in this series — which I think we’re just around 50 episodes at this point.

So there are actually a number of studies that have looked at this question. And in the research world, this is termed fertility-focused intercourse — so when you are specifically tracking your cervical mucus patterns, using fertility awareness techniques, and having sex during the six-day window of fertility. What the research has shown consistently is that pregnancy is possible when intercourse takes place during the six-day window of fertility that ends on your day of ovulation.

So when we’re looking at cycle tracking from a fertility awareness standpoint, you can’t predict ovulation ahead of time in the sense that the purpose of fertility awareness charting isn’t to predict ovulation — isn’t to be able to say, okay, I always ovulate on day 15, so this cycle I’m predicting I’m going to ovulate on day 15. When you dive into the fertility awareness weeds, the goal of charting is to identify your fertile days. And so we do this on a day-to-day basis.

Depending on the method that you’re using — for example, I teach the symptothermal method — the primary way of identifying those days of fertility is by tracking your cervical mucus patterns. And so when you are in your pre-ovulatory phase, so leading up to ovulation, and you start to observe cervical mucus — it can be the clear stretchy slippery type, it can be the creamy white hand lotion type — those days are considered fertile. Essentially, you’re trying to determine: am I fertile or not? And the premise is that hormonally, we’re producing this mucus in response to rising estrogen as we approach ovulation, and the mucus has the capacity to keep the sperm alive for up to five days. And the days that we have that clear stretchy mucus in the highest quantities are typically correlated with the highest levels of estrogen, which tend to happen really close to ovulation.

So we’re not predicting okay, I know exactly what day I’m going to ovulate on — but based on all of this information, if you time sex based on those days of what we would call peak fertility, then you are increasing your chance of having that sperm be captured by mucus and directed into your reproductive tract so that they will be there ready and waiting for when the egg is released.

So this is the basis of today’s study. But like I mentioned, there’s a number of studies that have actually tracked this information. And in my experience, I think that there’s this kind of thought of: how could you mess this up? If you’re not using protection, of course you’re going to get pregnant. But because we have been brainwashed in a number of ways about our reproductive situation — not only do we think that we can get pregnant on every day of the cycle (because that’s basically what our education system teaches us), we’re also taught that all cycles are 28 days with day 14 ovulation. So there are couples who mistakenly use this logic and have sex around day 14 only.

There’s a study that I’m thinking about where ovulation only happened around day 14 about 13% of the time — there was a variety of different days that ovulation can take place. And just when you’re tracking regular women and regular cycles, you’ll see that there is a range. So long story short, a lot of women don’t ovulate on day 14. And so if you have couples using this kind of rhythm method strategy — where they’re always making sure to have sex around that day based on this idea that that’s when ovulation takes place — if you happen to ovulate earlier or later than that, you could be inadvertently reducing your chances of conception by not timing sex on those optimal days.

So in this study, what’s interesting is not only did they have the couples aim to have sex in the window — this particular study wanted to look at whether timing sex specifically on those days of peak fertility, compared to days of what they termed low fertility, would even further increase the chances of conception. And that’s what we’re going to be talking about today.

So a little bit of background on the study itself. The researchers are looking at this question because although there has been research in this area, they wanted to further look at: if we’re specifying the days of peak fertility, does that further increase the chance? When you look at just what the research says about this topic, women are starting to seek information about their fertility in larger numbers. And interestingly, you would assume that somebody who has been trying to conceive for a while would be the most educated about what’s happening in their cycle — you would assume that. But when research is done to gather information about women’s understanding and general fertility awareness as it pertains to trying to get pregnant, very few women are able to correctly identify their fertile days.

So from the practitioner standpoint, there’s a huge opportunity to educate your clients. Never assume that just because someone’s trying to get pregnant that they really truly understand which days are optimal for fertility. Many women use ovulation strips — we’ve talked a lot about that on the podcast, which can be an incredible tool alongside your actual fertility awareness knowledge — but it doesn’t necessarily mean that each woman using them fully understands the fertile window.

Because there’s a huge difference between trying to identify which day you’re ovulating on and then having sex on that day. It feels more like luck. Like: okay, which day am I ovulating on? These strips are going to tell me which day. So instead of thinking about your fertile window — this six-day window — you’re thinking about one day. And that could even have an impact on your actions, because maybe that results in you having sex one day. And that one day, if it’s mistimed, may not be helpful, versus the mindset of understanding the role of cervical mucus and then thinking about it within a window and having sex within that window.

One of the key pieces that the researchers highlight in this study is that they point out that the current official recommendations related to timing sex are still: have sex every other day all the time, basically. And these are the standard recommendations that medical professionals learn in their programs. And the researchers point out that these recommendations are actually not evidence-based. So one of the driving factors to do research like this is to really build the evidence for a more targeted approach based on fertility awareness techniques. Because to this day, when you go to your MD, when you go to your standard medical practitioner, they’re telling you to have sex every day or every other day. I had a client whose doctor told her to have sex five times a day. This information and these recommendations — they’re not based on what the research is actually saying. And they’re not necessarily increasing your chances of conception, because what we need to do if we want to increase the chances of conception is hit those days in that fertile window and identify those days of peak fertility based on mucus.

So in this particular study, they taught their participants to identify which days of their cycle were high and peak fertile days compared to days of low fertility. Option one was to track cervical mucus — they taught the women how to identify the different types of cervical mucus so that they could categorize whether what they were observing was peak fertility, high fertility, or low fertility. The days of peak fertility were defined as days when they observed mucus that felt slippery and was clear and stretchy like egg white. Days identified as high mucus were still stretchy but could be cloudy. And then they identified days of low fertility based on either having no mucus or having a minimal amount of sticky, non-stretchy mucus.

Option two: the researchers in the study are also associated with the Marquette Method. If you’re not familiar with the Marquette Method, it is a sympto-hormonal method that relies on the ClearBlue fertility monitor. So instead of going directly to cervical mucus, the ClearBlue monitor allows a woman to measure her urinary metabolites of estrogen. As you’re approaching ovulation and your estrogen levels are rising — causing you to make all this mucus — you’re able to test the urinary metabolites. The monitor will tell you if you are in your high or peak days of fertility versus low fertility based on your output of urinary estrogen metabolites. So these methods are very complementary — essentially they’re testing for the same thing. One is doing it directly from the hormone output and the other is doing it based on the mucus, which is the result of the hormone output.

In this study they included 124 women and measured their behavior prospectively — meaning they taught these women how to identify the different fertility levels, and tracked them for a period of a year or more. These women were obviously trying to conceive, and they tracked their menstrual cycles and identified when they were having sex. So the researchers were able to identify whether or not the women were following the correct use recommendations — specifically having sex on those days of high or peak fertility, the days where they have the cervical mucus of highest quality, versus days where they had no mucus or just what they termed low-quality cervical mucus.

The average age of the women in the study was about 30, ranging from age 20 to 42. The average time that the couples had been trying to conceive was about four months. So you had couples who hadn’t even started trying yet, but you also had couples who had been trying to conceive for a year or more.

And the results were really interesting. The way that they gathered the data allowed the researchers to identify how many cycles were charted in total, and out of those cycles, how many had sex specifically marked on the days of high or peak fertility versus the days of low fertility. So they were able to compare the difference between the pregnancy rate for those who had timed sex on those days of high or peak fertility versus the days of low fertility.

And the results I think are pretty staggering. They used a marker of basically how many women out of a hundred conceived within 12 months of trying, based on whether they had sex on those higher peak days or whether they had sex on the low days of fertility. In their study, 87 out of 100 women were pregnant within 12 months when they had sex specifically on the high or peak days — compared to 5 out of 100 women who got pregnant when intercourse happened outside of those days.

And so what this study shows is that not only timing in the window, but timing specifically to the optimal days — those days of clear stretchy cervical fluid that is slippery and in the highest quantities — that makes a significant difference. Even for some of the couples who had been trying for quite some time, there was still a fairly high pregnancy rate.

What I always say is that timing is not everything, but it is essential. If you don’t have sex at the right time in the cycle, pregnancy can’t happen at all — this is the reason why fertility awareness can be used as a birth control method. So correct timing is really essential. But it’s not everything. It does help you to identify if there are other fertility issues, because generally speaking, the research around fertility awareness-based methods and what they term fertility-focused intercourse is that — instead of thinking you have to have sex for a year to see what happens (which is the common medical approach) — if you’re timing correctly based on your cycle, based on mucus or those days of peak fertility, they suggest that within six months a healthy couple would conceive. So instead of waiting a full year for an evaluation, they would recommend pulling that date up to the six-month mark.

So I would say: timing is essential, but it’s not everything. But without the timing, you don’t have anything. Because if you’re not hitting those correct days, then really and truly you might not have a fertility issue — you might just have a timing issue. And although it might seem kind of crazy, it is possible to have sex a lot and if you’re not hitting those days, to not get pregnant. That is again the basis for using this method for birth control. And it’s easier than you think. All it takes is a couple of days of travel, maybe a couple of days of illness, if you and your partner work opposite schedules. Especially for couples who’ve been trying to conceive for a while — sometimes the sex is literally only happening in the window and there’s only one or two days. So if those one or two days are wrong month after month, it really can happen.

Whether you’re tuning into this episode for yourself to optimize your chances, or if this is something you’re wanting to dive deeper into to support your clients — never assume anything. Even if you yourself have charted your cycles, always take an opportunity to re-evaluate. Make sure that you’re noting the days that you have sex, because you won’t remember it in retrospect. Then compare the days you were having sex to the actual day of ovulation. Evaluate: are you actually having sex in that window? And based on the definition we went through today — are you hitting those days of peak fertility consistently every cycle?

Even if you know this stuff, knowing and doing are not the same thing. You might think you know it inside and out, but then when you look back you might be like: oh wait, in October that was the month I was away. In August I was really sick that week. In July that was the week my cat had to go in for surgery. And all of a sudden you realize that even though you know this stuff — was sex actually taking place at that time?

This is the reason that when we look at these types of studies that literally only change timing, I’ve seen numbers as high as 30% where you have couples who have been trying to conceive for whether it’s six months, a year or more — they haven’t been successful — and all they change is timing. And there always is a percentage of couples who, with only the change in timing, do conceive.

So to kind of bring this all together: the guidelines commonly given to women around timing sex are just totally out of date. In Real Food for Fertility, in the conception chapter, I went to town on this concept of frequency and timing. The advice of having sex every other day is based on the idea that men make sperm every day and having sex every other day theoretically gives the opportunity for sperm numbers to build up. But ultimately, when you look at the research in its entirety, you’re not going to increase your per-cycle chance of conception higher than the upper limit regardless of how many times you have sex in that cycle.

When we’re looking at healthy couples trying to get pregnant, when they have sex during that six-day fertile window, the most I’ve seen in a research study in terms of percent chance per cycle is about 30%. Typically it’s about 25% on average — a 25% chance per cycle. So when you have an average healthy couple trying to get pregnant with no fertility issues, the average percent chance per cycle is 25 to 30%, which means that on average you can expect up to four cycles of trying, and that would be considered normal. Whether you’re having sex once on that peak day of fertility, or whether you’re having sex 10 times — having sex 10 times in the window doesn’t mean that your chance goes from 25% that cycle to 85%. The chance per cycle is still 25 to 30%.

So the current recommendations are just not evidence-based. Telling someone to have sex every day or every other day, but not actually outlining that there’s only a six-day window, is just not good advice. What it does is it fosters confusion. It does not increase a person’s education or understanding around what’s happening in their cycle. It’s kind of like playing darts in the dark — you can’t even see the dartboard and the person is just telling you to keep shooting darts. Like, you don’t know where the dartboard is. Should we turn on the lights and show them where the dartboard is, and then tell them to shoot at the dartboard? Telling couples to just have sex every other day, or just have more sex, is the dark dartboard analogy. Now you can be more strategic.

Not to say that having more sex can’t be beneficial for your relationship and bonding — but when you’re trying to conceive, many couples are fatigued. And one of the benefits of understanding the fertile window is knowing when it really counts and knowing when it doesn’t — knowing when it’s not going to result in pregnancy. Because that gives you an opportunity to have sex that is not feeling pressured or associated with trying. If you’re tracking your cycle and you know that you’ve already ovulated, you could have sex knowing that it can’t result in pregnancy — you could just enjoy it and relax versus being in that dark dartboard scenario and always feeling like it’s a try.

And this is something where you may think that you understand these fertility awareness principles, but I’ve worked with clients where their partner was out of town during the window — they had lots of sex before he left and after he left — not in the window at all. And I’m looking at the cycle knowing that there’s virtually no chance of pregnancy because there was no sex in the window. But even though that is the case, there was still sex. So at the end of the cycle there’s still that disappointment, because you still think there’s a chance — because we’ve been so brainwashed to think that pregnancy can happen on any day of a cycle.

So the huge takeaway from the study: we need to shift from these guidelines that are not evidence-based and move toward what actually is going to make the biggest difference. Timing is more important than frequency. Identifying those days of peak fertility and timing sex based on those days — even if you have less sex in the cycle — the sex you have is going to count.

The other takeaway from this is that it’s time that we really increase the education of women and couples around fertility. There’s a huge lack of education, and to this day this fertility awareness knowledge is still not commonly taught. For even yourself — think about how you found yourself listening to this podcast. How did you find it? Someone has to tell you about it, or someone has to recommend it. And thank you to all the people who recommend and spread the word, because that’s really how this is happening and how these changes are happening. But even in today’s day and age, it’s really not common knowledge.

There was one other interesting finding in the study, and I’ll give it a little nod. The researchers, when they were assessing the data, in addition to identifying the percentage of women who conceived by having sex on the peak days versus not — they also separated out by age: women who were over 30 versus under 30. And what they found was that the women who were under 30 had a much higher rate of pregnancy compared to the women who were over 30. It was statistically significant. And this speaks to changes with age.

Now, one thing I’ll point out is that they always kind of pick on the age of the woman. But generally speaking, as women are older, our partners also get older. So this issue with age could be related to her age specifically — age is certainly highly correlated with fertility — but it’s also likely a combination of her age plus her partner’s age. And this is another area where we are not really educated about. Fertility does change with age and it is something that we want to be aware of. Once we get into that older age range — like myself, I am 42 — if you’re trying to conceive, it is a good opportunity to look deeper into optimizing fertility, optimizing egg and sperm quality, and really learning more about some of the challenges that can occur as you get older. The takeaway is that there’s still opportunity for you to make improvements and changes to increase your chances — the strategy may just have to be a little bit more targeted.

I hope that you enjoyed today’s episode. I was excited to share this research study. I love research studies that are done by researchers with a background in fertility awareness who are able to go more into the weeds. Many research studies that touch on fertility awareness aspects don’t necessarily go into this much detail where they’re educating the participants about the different types of mucus and having them time sex based on those nuances. So it is really neat to be able to see research being done like that, and to see this peer-reviewed evidence that shows us that these techniques really do improve the chance of conception — and to highlight that difference between what the research is showing and what’s done in practice.

Just as a reminder: on average, it takes anywhere from about 10 to 20 years before the newest research is adopted into routine medical practice. So what we’re seeing is in line with that. And that’s where we come in — to really close that gap so that we’re sharing this information with women and couples who need it today, who can’t wait 20 years before this is adopted into routine medical practice.

So I hope that you have a wonderful weekend whenever you’re tuning into the show. If you enjoyed today’s episode and you know somebody who can benefit from it, please share — the share link is fertilityfriday.com/563. And if you are enjoying these research series episodes, head over to fertilityfriday.com/research for the full list. So as always, until next time — be well and happy charting.