Sex Frequency for Conception: What the Research Shows (Episode 502)

Full Transcript: Episode 502

Lisa Hendrickson-Jack:
This is the Fertility Friday Podcast, episode number 502. Today I’m sharing a brand new episode in my FAM Research Series. Today I’m going to be diving into the question of how much sex is necessary for conception. Should we be having sex every single day? Should we be having sex every other day? Should we be having sex multiple times a day? So I’m going to be going over an interesting research study in today’s episode where we target an important aspect of this question, which is, you know, is there a benefit to having sex every single day? So without further ado, let’s go ahead and jump into today’s episode.

All right. So today’s episode is really inspired by a number of conversations that I’ve had with clients over the years that have led me to dive deeper into the research around the impact of more frequent ejaculations on sperm numbers. The study that we’ll be looking at today, it looked at men going through a series of repeated ejaculations. So I just always think, like, who designs these studies and what are the participants thinking? But ultimately, in this particular study, they had a small group of men ejaculate all in the same day at regular intervals. And so they did the first evaluation at 6:00 in the morning, the second at 8, the third at 10, and the fourth at noon. So every two hours, they had these men ejaculate and then they took the sperm samples and measured the typical sperm parameters. So they measured semen volume, concentration, total sperm count, motility, and etc. etc. So they measured a variety of different markers and so it really gives us the data on what is the impact in this particular study of repeated ejaculations which would give us some insight into that question of is it worthwhile for me to have sex multiple times a day or how frequently should I be having sex when I’m trying to conceive?

And although it might seem unreasonable, I feel like for most people, when you hear that concept of like what, you want me to have sex more than once a day, it might sound a little bit out there, but I have had a number of conversations with clients over the years who have been given advice like that. There are doctors telling them to have sex every single day or every other day or multiple times a day. I had a client tell me that her doctor told her that she should have sex five times a day to optimize her chances of conception. And when it comes from a medical health professional, it has so much weight and can really either cause us to feel stressed or cause us to feel like we’re not doing enough or the right thing or just cause us to kind of question because it does sound a bit unreasonable. So that’s why I really like this study because then it goes away from our emotions around it and just kind of looks at, well, is it helpful from that standpoint of what impact does it have on the numbers?

So I’ll go into the study a little bit and share some of those results because I think it’s really interesting. They didn’t have the biggest sample size, like I don’t know how easy it would be to find participants to kind of go through this kind of protocol here. But ultimately, what they did is they had a few healthy men who then provided their samples after about three to four days of abstinence. So they had these men kind of organize themselves in such a way that they could get these results. And not only did they look at the sperm parameters that I mentioned, they also looked at the quality of the DNA of the sperm. So they looked more deeply into that. And I think that that’s an interesting — they kind of had some interesting commentary on that because when a couple is undergoing artificial reproductive technology, some of the studies show that if a man ejaculates first, and then like an hour or two later, he ejaculates again, that there are times when the sperm DNA might be a little bit better, but that strategy applies more specifically to artificial reproductive technology like IVF or something like that, because I mean, in that case, they may only have to extract a small number of sperm. And so that could be a benefit to them. But when we’re looking at natural conception under normal conditions, then the question we really have is like, is this really going to benefit me?

So let’s talk a little bit about the results. So from the first evaluation at 6:00 in the morning, the average total sperm count — so they’re kind of, you know, they’re estimated, this is how many sperm that you have in the sample — was about 175 million. And after the two hours when they did the second evaluation, that number went down to 46 million. So within that two-hour span, the second ejaculation had about a quarter of the total number of sperm as the first. The third was similar in range, 42 million. So very similar to the two-hour interval. But by the fourth evaluation, that number was down to about 28 million. So from the standpoint, it might sound like a lot, you know, oh, 28 million, etc. But when it comes to, if you think about what natural conception would have to look like, I mean, if you’re intimate with your partner, then half the sperm are going into the wrong tube, like the whole ejaculate doesn’t remain in. So even though there’s a large number of sperm, you know, the question really is like how many actually make it into the fallopian tube. So something to keep in mind.

But what the data shows us is that there’s a significant drop, very significant drop if men are having repeated ejaculations within the same day. And so with that data in mind, just by looking at the data and not by thinking about the emotions around it, it would seem like there could potentially be a benefit to having sex more than once a day, because it’s not that there was no sperm, he still had sperm. So there could theoretically be some benefit, but from a practical standpoint and if you look at the numbers with such a huge drop — dropping like 75% less sperm after that first ejaculate — and by the fourth one they’re just being — I’d have to do the math on that but like 80% less or something like that — just like so such a small number in comparison that I think it’s safe to say that the results show us that any potential benefit is negligible from having sex multiple times a day because the numbers drop so drastically that I don’t know that we can really argue that there’s a significant benefit. So theoretically there could be a benefit because he’s not running out of sperm and you are certainly adding to the pool, but given the significant drop, it may be more worthwhile to approach this a little bit differently.

And what’s interesting is when I was looking at this question, this wasn’t the only study that I looked at. So there’s another study that I looked at as well that I’ll mention briefly that may be fun to go through in a separate research series episode. So this other study that I looked at, they instead of looking at multiple ejaculations in one day, they were looking at a more serial ejaculation approach. So they had their participants ejaculate daily for a couple of weeks. And what was interesting about that study is it did show a similar trend where the first ejaculation was a bit more often happening after a few days of abstinence. And then the second ejaculation the day after did show a fairly significant decrease in the total number. If I remember correctly, it was something like an average of 30% or something like that where there was an initial dip. What was interesting about that other study that I’m mentioning was that after that initial dip, there was a bit of a plateau and although there was still fluctuation from day to day, there was kind of like a set point and you can see that it’s not to say he’s going to run out of sperm — there was a set point where it was pretty consistent after that initial drop.

And so again that would indicate that theoretically there could be a benefit to having sex multiple times throughout the window or even multiple times a day but we have to really look at how much more — how much more is this really giving me? You know, how is it really worth the hassle?
So I want to share some of my takeaways then from this data and just going through this conversation with multiple clients over the years and helping my conception clients to really strategize on this question of frequency. And so my take on this question is that timing is more important than frequency.

I find that a lot of the advice that is given to women to have sex every other day or multiple times a day or every you know other — like whatever it is, every single day or every other day or whatever — often this advice is not within the context of cycle charting. And so you don’t really have the woman being able to identify that fertile window and really narrowing in, zoning in to that window. So when we look overall, the fertile window lasts about a week or so. From a scientific standpoint, it’s the five days leading up to ovulation plus ovulation day itself. And when you’re charting, you can identify that window by paying attention to your cervical fluid, among other signs. And from that perspective, the most important sign to watch for is your mucus. And so you would consider yourself fertile on any days that you observe mucus, whether it’s the clear stretchy or creamy lotiony as your pre-ovulation. And of course, we always consider peak mucus — peak is clear, stretchy, or lubricative — as optimal for conception.

So you can go a long way just by timing sex based on the mucus. And studies have shown that for women who are taught to identify the different qualities of mucus and who are instructed to aim to have sex on those days of their highest quality mucus — so the clear, the stretchy, the lubricative, etc. — that can significantly increase your odds of conception. And so that’s something to think about as well. When looking at these questions of frequency, I think that we are often losing the plot, because the most important thing is that we time sex correctly. I mean, you can have all the sex you want, but if you don’t hit the window, it doesn’t even matter. Like, you could have sex almost every single day, but if you don’t actually have sex during that six-day period of time, then it’s just not going to result in a pregnancy, most likely, and this is why fertility awareness can be used so effectively for birth control.

The other thing I think is important is that when a couple has been trying to conceive for quite some time and they have not been successful, from a statistical standpoint he is much more likely to have poorer sperm parameters. When I look into research around conception and fertility and infertility, it’s quite clear that couples who have been trying for longer periods of time — when they evaluate the male partners and do an analysis on their general sperm parameters — the partners within these couples who’ve been trying to conceive for a year or more or two years or more are much more likely to have lower sperm parameters. So I think sometimes focusing on the frequency piece of it can take us away from some of the more important questions that we should be looking at, like what is his sperm quality like? Has he been tested? Do we need to improve his sperm quality, or are there things that we need to be doing to improve whether it’s the count or the motility or the morphology? Are there things we should be looking at there?

And so then what is the answer? How much sex should you really be having? So there’s a couple of things. One is that I know, for example, the every-other-day advice that we hear — I feel like it’s not given in a proper context. I think that it’s helpful to know that all couples don’t actually have to do things to adjust their frequency. For many couples, it’s good enough to simply have sex during the fertile window one or more times and consider every additional time as a bonus. So I think that’s a good takeaway from today’s episode. So there may be a benefit to increasing the frequency of having sex. There may even be a benefit to having sex multiple times a day. But what the research tells us is that generally speaking, it’s not like you’re getting so much more sperm, especially in the case of multiple ejaculations in the same day.

So then what do you do? The most practical advice is to have sex once or more times during the window, and you can choose to have sex every other day if you want to. I would say it’s not necessary — everyone doesn’t need to do that. If you suspect that your partner has issues with lower sperm quality or quantity, then in that situation it would make the most sense to potentially modify your frequency. But if you are just newly starting to try to conceive and you don’t necessarily have any concerns about his sperm numbers or anything like that, then it may be worthwhile just to make sure that you hit that window once or more.

Ultimately, if you want to have sex multiple times a day, every single day, every other day, indefinitely — if that’s something that excites you, that feels right for you in your relationship, that does not feel overwhelming and does not feel like a chore, if it’s something that feels really good for you, feels positive and you and your partner are excited about it, then by all means, you know, if you’re trying to conceive and you want to have that much sex, there’s nothing in the research that would indicate that it’s detrimental. If it’s something that you want, there are research studies that look at the stress related to different aspects of infertility. And so certainly there can be a negative effect of the stress related to feeling like you have to do this all the time. You know, many couples have things going on and maybe at different stages of their relationship where it can be hard to even find the time to have sex, whether it’s for fun in addition to the trying part or just to make sure that they’re having sex during that ovulatory period of time.

So I think for most couples, the pressure and stress of the thought of having to have sex every single day or multiple times a day — certainly the benefits are not outweighing the potential downsides, I think. So you can breathe easier and rest assured that when you’re trying to conceive, my opinion in this is that frequency is not as important as correct timing. So I’d rather see having sex once or twice during that six-day period than to have someone who’s trying furiously to have sex every single day or multiple times a day.

And although it can be — I think for a lot of people, a lot of women, a lot of couples — I mean, maybe even for yourself as you listen to today’s episode — for a lot of people that can feel kind of like, no, that can’t be right. Like I can’t just have sex one time and conceive, it feels like I should be trying harder. But for healthy couples of normal fertility, it’s completely within the realm of possibility to conceive from having sex like literally one time during that window. Now, I’m not necessarily recommending it — it’s your comfort. I say once or twice at least is enough.
But for couples who have been trying to conceive for quite some time and who are not having success, having more sex isn’t necessarily going to solve the problem. And I think that’s an important takeaway as well. What this frequency study shows us is that you can have sex multiple times a day, like you can have sex 10 times a day, but it doesn’t necessarily result in that much more sperm because of the significant decrease in overall sperm numbers as a result of these frequent ejaculations. So I think that’s something to be aware of as well, which is that more isn’t necessarily better in this situation. And it doesn’t necessarily increase your overall chances of conception enough to justify the stress of this recommended activity.

So I think I’m going to leave it there. If you enjoyed today’s episode and you can think of someone who would benefit from hearing it, the share link is fertilityfriday.com/502. For more episodes in the FAM Research Series, I’ll invite you to head over to fertilityfriday.com/research. And as this is the very first episode in 2024, I do want to take a moment to wish you a very happy new year and I want to wish you the absolute best in the year to come in 2024. And with that said, I hope you have a wonderful week — whenever you’re tuning into the show — and of course, as always, until next time, happy charting.