Timing Intercourse to Conceive

| Trying to Conceive guide |

The Role of Timed Intercourse

A First Step

Maybe you are considering starting a family. Or maybe you’ve been trying for a little while and aren’t sure if anything’s wrong, but you want to do what you can to help the process along. Or maybe you’ve been on this road for some time and are struggling to conceive and don’t know what to do next. Whatever got you here, you might be wondering, “Where do I start?” The first step of course in the process of conception is intimacy. However, because a couple is not fertile every day of the month, conception is not always possible as a result of intercourse. So, knowing when to have intercourse during each cycle is fundamentally important to supporting conception.

We’ve laid out a more foundational understanding of fertility on another page, but our focus here is more practical: How do we use this information to achieve conception? We’ll talk about how to learn your (wife’s) cycle so that you know when you’re fertile. We’ll also talk about the role of intercourse frequency and how it affects sperm quality, an obviously vital part of the process. In taking these two together, we’ll talk about when to prioritize intercourse to help support conception.

In addition to this benefit, understanding your (wife’s) cycle can help you identify when there might be a fertility issue to explore with a doctor. Additionally, the hormones at work behind the cycle drive so many things like fatigue, libido, and mood. Getting to know yourself and your cycle can help to take the mystery out of those things that might feel unpredictable by revealing the order behind them. But, of course, our main purpose here is trying to achieve conception. So, how does timing intercourse affect the chances of conception?

The Numbers

In our discussion on Understanding Fertility, we saw that the fertile window is generally from about 7 days before ovulation to 1 day after ovulation. In other words, conception can occur as a result of intercourse on any of these days. However, the chances of conception change depending on which day it is in this fertile window.

A 2019 study[1] used data from the Ovia fertility app to estimate the probability of achieving pregnancy as a result of intercourse. After reviewing 225,000 cycles from almost 100,000 women, they found that the chance of achieve pregnancy rose steadily starting 7 days before ovulation, peaked on the day before ovulation, and then dropped off more rapidly on the day of and the day after ovulation. The clear conclusion from their research is that the timing of intercourse has a big impact on the chances of conception. Here is a summary of their findings:

Source: Faust et al (2019), Fertility & Sterility

Timing Intercourse

Predicting Ovulation

The chart above makes it clear that the most central part of timing intercourse is knowing when you ovulated. So, how do you know when ovulation occurred? More to the point, since the best days for achieving conception occur before ovulation, how do you predict when you are going to ovulate?

Like we discussed on our page, Understanding Fertility, ovulation is part of the larger cycle. There are many different effects this cycle causes that can be monitored to predict ovulation. Here’s an overview of a few ways couples predict ovulation using these signs:

  • Hormonal Fertility Monitors: Estrogen levels climb ahead of ovulation and LH levels spike just before it occurs. Many fertility monitors track these hormones from urine tests you do at home. After doing this for a few cycles, the monitor tells you when your chances of conceiving are at their highest. Personally, we have used the Clearblue Fertility Monitor for this.  There are several hormonal fertility monitors that are based on this same concept. Some, like the Mira Fertility Analyzer, even integrate into apps on your phone which can provide more information and make understanding the results easier.
  • Tracking Vital Signs: Ovulation affects a woman’s body in so many ways. Her body temperature, heartrate, and respiratory rate are all affected by her cycle in predictable ways. Tracking this information can help identify when ovulation will occur. Many apps enable you to track this information and help you predict ovulation. For example, the Ava app comes with a bracelet that you wear while sleeping that tracks these vital signs. It syncs to your phone in the morning and tells you where you are in your cycle. This method has the benefit of avoiding the urine tests that hormonal fertility monitors require.
  • Cervical Mucus Observations: Like we discussed in Understanding Fertility, the consistency of cervical mucus changes throughout the cycle. A woman can actually notice these changes. The discharge becomes clear, “slippery” and stretchy just before ovulation. After ovulation, it becomes thicker, cloudy and less noticeable. There are apps that help you learn what you’re looking for in making these observations and help you track it. The challenge Monica and I experienced in using this method is that there is a learning curve in making consistent and reliable observations. However, one of the systems (FertilityCare) that uses these mucus observations has the benefit of being part of a larger approach to fertility. FertilityCare includes a network of physicians that can use the information in the app to help diagnose and treat fertility issues.

Any of these approaches takes at least a few cycles to learn how your body works specifically to accurately predict ovulation. Knowing when you’ve ovulated is the most important part to knowing when to time intercourse, but let’s not forget the other half of the equation.

Helping Sperm Quality

Quality sperm is obviously essential for conception. Ovulation tells us when to have intercourse for conception. Sperm quality tells us how frequently to have intercourse for conception. (There’s a joke in there somewhere.) A 2016 study[2] demonstrated that while longer abstinence allows for more sperm, it reduces sperm quality. Once sperm has been made, it essentially has a shelf life. As sperm begins to age, the DNA that each sperm carries begins to fragment and degrade. If there isn’t enough quality DNA when the sperm reaches the egg, then conception cannot occur. Also, this DNA contains the instructions for baby to grow, so quality sperm can help to reduce the risk of miscarriage – something we all desire.

A study[3] conducted in 2019 concluded that abstinence of more than 4 days had a detrimental effect on sperm DNA.  This study demonstrated that intercourse at least every 4 days produced significantly higher rates of successful fertilization, healthy embryos, successful implantations, and overall pregnancy rates. Furthermore, intercourse every day showed improved implantation rates even when compared to every 2, 3, or 4 days. The Mayo Clinic[4] similarly notes that the highest pregnancy rates occur among couples who have intercourse every day or every other day. Of course, it’s not always possible to make time for intercourse this frequently – life is busy after all. So, when should we prioritize intercourse to conceive?

Timing & Frequency of Intercourse

The simplest solution to all of this is to have intercourse every day or every other day. With that frequency, you don’t have to know when ovulation has occurred to achieve conception. However, it can be difficult to make time for that every (other) day. Also, tracking and understanding your (wife’s) cycle has many other benefits, including helping you identify potential fertility issues. So, how can we pull all this together to know when we need to prioritize intercourse to improve our chances of conceiving?

As a baseline, having intercourse at least every four days (twice a week) helps to keep the sperm healthy. As mentioned above, sperm quality improves the chances of conception, implantation, and helps to reduce the risk of miscarriage. Beyond this, however, tracking your (wife’s) cycle allows you to know when you have the best chances for conception to occur. As the graphic above demonstrates, this fertile window begins 7 days before ovulation and includes up to one day after ovulation, with the best chances for conception in the days just before ovulation. If you are able to prioritize intercourse to every day or every other day during this window it helps to support conception.

Before concluding, I’d like to talk about a few other things that we can do more generally to support conception and a healthy pregnancy. Also, I’d like to talk about how to tell when it might be time to talk with your doctor about a potential fertility issue.

What Else Can We Do?

General Health and Fertility

Our general health can contribute to our fertility. For men, as we discussed on our Understanding Fertility page, there are several environmental and health factors that can reduce the quantity and quality of sperm produced. For men, the Mayo Clinic[5] recommends:

  • Avoiding smoking and drugs,
  • Limiting or abstaining from alcohol,
  • Avoiding prolonged heat for the testicles (including hot tubs, saunas, and even using a laptop on your lap),
  • Reducing stress,
  • Avoiding exposure to pesticides, heavy metals and other toxins.

They also recommend keeping an eye on our weight since extra weight can impair male fertility in several ways.

Weight can also affect a woman’s fertility; being underweight or overweight can affect ovulation and increase your risk of PCOS. Additionally, diabetes and insulin resistance are risk factors for PCOS. In fact, managing these conditions with the anti-diabetic drug Metformin has also helped reduce the symptoms of PCOS. Of course, diabetes and PCOS (along with other fertility conditions) would need to be diagnosed and managed with your physician. Similar to a man’s fertility, a woman’s fertility can also benefit from avoiding smoking, limiting alcohol, and reducing stress.  Additionally, strenuous exercise (more than 5 hours per week) has been associated with decreased ovulation.[6]

Progesterone and Implantation

As we discussed on our Understanding Fertility page, the hormone progesterone plays a vital role in supporting a healthy lining in the uterus. Thus, low levels of progesterone increase the risk that the baby will not be able to implant in the uterus as well as the risk of miscarriage in the first trimester.  One of the benefits of tracking your (wife’s) cycle is that this can often help to identify whenever progesterone levels are low. Early spotting before your period is one of the most notable signs; strong PMS symptoms can also be an indication that progesterone levels are falling off too rapidly at the end of your cycle.

The good news is that low progesterone levels are relatively easy to address.  Progesterone levels are easy to measure and supplemental progesterone is available by prescription. If you suspect that progesterone levels might be an issue for you, speaking with a physician about it may help to reduce the risk of miscarriage and aid in healthy implantation.

Supporting a Healthy Immune Response

One of the risks in pregnancy is that our immune system essentially gets confused and mis-identifies the baby as a foreign infection. There is also something that we can do to help our immune system recognize a pregnancy. One of the most incredible parts of God’s design for pregnancy occurs after intercourse even whenever conception does not occur. After the husband’s semen is deposited on the wife’s cervix, her white blood cells rush down to analyze his sperm. His sperm each contain a sample of his DNA. Her immune system is learning her husband’s DNA so that it will recognize the baby when she becomes pregnant by him. This amazing design has been shown to reduce the risk of preeclampsia by two-fold in some studies.[7] [8] (It also has a spiritual parallel that I hope to share in a post soon).

With all this talk of timing intercourse to conceive, this serves as an important reminder that even intercourse outside of the fertile window can be an important part of helping support a healthy pregnancy. (This is also true of intercourse outside of a season when we are trying to conceive.)

When to Talk with a Doctor?

A doctor can certainly help in this process by measuring and timing support for the various hormones that regulate the process, by identifying and treating potential fertility issues, by performing an analysis on sperm quality, and in many other ways. However, many couples are understandably hesitant to start down that road of involving a doctor right away. One of the benefits of understanding your (wife’s) cycle is that it can help you to notice potential fertility issues so that you know when you might need to talk with a doctor. If you make notes about what you learn about your (wife’s) cycle, it also helps give the doctor good information to make a better diagnosis.

A study[9] of women from 20 to 44 has shown that about 38% will conceive within one month of trying, 68% within three months, 81% within 6 months, and 92% within a year. If you have been trying to conceive for 6 months, it may be time to talk with a physician and see if they can help. Additionally, if you know or suspect that there might be fertility issues like PCOS, endometriosis, or thyroid issues, involving a doctor early in the process allows them to help to manage these issues. The good news is that if you have been tracking your (wife’s) cycle, then the information you have might help you and your physician identify where the problem might be.

For example, as mentioned above, early spotting before your period starts might be an indication that you need progesterone support. Also, you may be able to identify that ovulation isn’t occurring consistently, so you might need help stimulating ovulation with a medication like Clomid. You also might notice that ovulation is occurring, but even with timed intercourse you aren’t able to conceive. Perhaps this might lead the physician to look at progesterone support or maybe a semen analysis to determine if there are male fertility issues at play. Whenever you track your cycle, you’re better able to identify the patterns that help to inform your diagnosis and treatment. All of this can serve to support a healthy conception and pregnancy and speed along the process of trying to conceive.

Of course, not all doctors have the same approach. Personally, we felt most comfortable with doctors who are affiliated with FertilityCare. This was not only because they have an emphasis on protecting life from conception, but because the science behind their approach is well researched. If you are interested, you can find a list of these physicians here.

As a brief aside, if you have been trying to conceive for some time and are considering IVF, please review our IVF guide for Christian couples before you decide. The IVF process can be a difficult one to navigate while protecting the children that are conceived in the process and which method you use can make all the difference. You can take a look at that guide here.

[1] Faust L, Bradley D, Landau E, et al. Findings from a mobile application-based cohort are consistent with established knowledge of the menstrual cycle, fertile window, and conception. Fertil Steril. 2019;112(3):450-457.e3. doi:10.1016/j.fertnstert.2019.05.008

[2] Agarwal A, Gupta S, Du Plessis S, et al. Abstinence Time and Its Impact on Basic and Advanced Semen Parameters. Urology. 2016;94:102-110. doi:10.1016/j.urology.2016.03.059

[3] Borges E Jr, Braga DPAF, Zanetti BF, Iaconelli A Jr, Setti AS. Revisiting the impact of ejaculatory abstinence on semen quality and intracytoplasmic sperm injection outcomes. Andrology. 2019;7(2):213-219. doi:10.1111/andr.12572

[4] Mayo Clinic: https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/how-to-get-pregnant/art-20047611

[5] Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/male-infertility/symptoms-causes/syc-20374773

[6] Mayo Clinic: https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/how-to-get-pregnant/art-20047611

[7] Klonoff-Cohen, H., Savita, D., Cefalo, R., & McCann, M. (1989). An epidemiologic study of contraception and preeclampsia. Journal of the American Medical Association, 3143-3147.

[8] Hernández-Valencia, M., Saldaña Quezada, L., Alvarez Muñoz, M., & Valdez Martínez, E. (2000). [Barrier family planning methods as risk factor which predisposes to preeclampsia]. Ginecologia y obstetricia de Mexico, 68, 333–338.

[9] C. Gnoth, D. Godehardt, E. Godehardt, P. Frank‐Herrmann, G. Freundl, Time to pregnancy: results of the German prospective study and impact on the management of infertility, Human Reproduction, Volume 18, Issue 9, September 2003, Pages 1959–1966, https://doi.org/10.1093/humrep/deg366