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Best Sexual Frequency for Pregnancy?

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a blog by Laurence A. Jacobs, M.D., Fertility Centers of Illinois, June 7, 2011

Couples attempting to conceive will often ask me “What can we do to improve our fertility/chance of conception?” They often ask what the ideal frequency for sex is.

Ideal Sexual Frequency

There has been no research-based consensus among fertility doctors (reproductive endocrinologists or REs) regarding sexual frequency when couples are trying to conceive a baby — whether they are undergoing fertility treatments or trying on their own. The general thinking for years has been that during the seven to 14 days before ovulation, ejaculation every two to three days results in both good sperm production (sperm counts) and motility.

Most fertility doctors will then recommend couples having sex every other day around the suspected time of ovulation (mid-cycle) if couples are not monitoring a cycle with an ovulation predictor kit (OPK). If couples are using an OPK for monitoring the luteneizing hormone (LH) surge, or an hCG injection to induce ovulation, having intercourse on the day of ovulation (or just before) offers the highest chance of pregnancy.

However, interesting new research shows it actually may be beneficial for the sperm if men have sex much more frequently in the days/weeks leading up to ovulation or in vitro fertilization (IVF). If you’re trying to achieve a pregnancy, you might want to increase your sexual frequency! Read on.

Reactive Oxygen Species (ROS) vs. Antioxidants

Recent scientific evidence has revealed that a condition known as “oxidative stress” may be a factor in some of the causes of male factor infertility.

Reactive oxygen species (ROS), also referred to as "free radicals," are chemically-reactive unstable molecules containing oxygen. ROS forms as a natural byproduct of the normal metabolism of oxygen. Free radicals/ROS are produced through a number of normal internal functions of the body, but may increase when the body is subjected to various conditions, especially certain toxic environmental exposures; for example, heat. ROS/free radical levels can increase dramatically, resulting in significant damage to cell structures. Harmful effects of ROS on the cell most often result in damage of DNA.

There is considerable evidence regarding the damaging effects of "oxidative stress" on sperm function. The free radicals/ROS are normally kept under control by the presence of antioxidants in the testicles, semen and epididymis. Oxidative stress occurs as a result of an imbalance between the amount of free radicals/ROS and the total protective antioxidant capacity in the semen and testicle/epididymis. When the ROS exceeds the protective antioxidants, damage to the sperm may result, including DNA fragmentation and cell membrane damage.

Spermatogenesis is a process that takes several months for each sperm to be produced in the testicle, and then stored in the epididymis. The epididymis, abundantly rich in various antioxidants, such as Vitamins C and E, plays a major role in shielding sperm from damage from free radicals/ROS and other forces during storage.

Men should try to eliminate or avoid some of the presumed sources of increased ROS, such as heat exposure, varicocele, infection, smoking, etc. In addition, many experts believe that increasing one's nutritional intake of antioxidants such as Coenzyme Q10, Vitamin C, Vitamin E, Selenium and Lycopene may help reduce oxidative stress and DNA damage (fragmentation) as well. Many of the popular male fertility supplements contain these antioxidants, as well as the essential trace mineral zinc, and L-Carnitine, an amino acid.

Besides nutritional supplements for male factor infertility and/or increased DNA fragmentation from oxidative stress, perhaps another way to reduce the free radical damage to the sperm is for the sperm to spend less time in storage in the epididymis ... which means more sex.

Australian Study: Sperm Quality Increases with Frequent Sex

David Greening, M.D., an Ob/Gyn and reproductive endocrinologist at Sydney IVF in Australia believes that frequent ejaculation might be a physiological mechanism to improve sperm DNA damage, while maintaining semen levels within the normal, fertile range. To investigate this hypothesis, Dr Greening studied 118 men who had higher than normal sperm DNA damage as indicated by a DNA Fragmentation Index (DFI).

The fertility researchers found that daily sex (or ejaculation) for seven days improved men’s sperm quality by reducing the amount of DNA damage. Dr Greening said the reason why sperm quality improved with frequent ejaculation may be because the sperm had a shorter exposure in the testicular ducts and epididymis to reactive oxygen species/free radicals.

This study showed that frequent sex (daily) decreased semen volume and sperm concentrations, but improved sperm motility and decreased sperm DNA fragmentation. It is important to note that this study evaluated sperm parameters, but not pregnancy rates.

Will Improved Sperm Quality Result in Better Pregnancy Rates?

Further research is required to see whether the improvement in the sperm quality due to more frequent ejaculation translates into higher pregnancy rates, but other studies have shown a positive relationship between less sperm DNA damage and better pregnancy rates.

For example, it has been shown that the source and quality of the sperm does influence outcomes of IVF. Sperm retrieved from the testicles (TESE) seems to have lower levels of damage than poor quality ejaculated sperm in some men. In these cases, sperm are damaged in the reproductive tract after they leave the testicle. Sperm inside the testicle seem to be better protected because of the high level of antioxidants within the testicle.

In couples who have failed multiple cycles of IVF, using testicular sperm during a subsequent IVF cycle has lead to better pregnancy rates in several studies and provides a new option in these selected patients.

Simple Solutions

These studies provide the rationale for my treating male infertility with innovative, inexpensive options — combining high levels of antioxidant supplements and more frequent ejaculation leading up to artificial inseminations or IVF. The men should have daily ejaculation/sex for seven to 10 days leading up to artificial insemination/IVF, but abstain the night before. If excessive free radicals/ROS lead to sperm DNA fragmentation and damage, and if antioxidants and frequent ejaculation can neutralize or reduce oxidative stress in the semen, then it would make sense that male supplements containing vitamins, minerals and antioxidants combined with more frequent ejaculation may improve sperm quality and lead to better pregnancy rates.