TTC Myths & Truths

Trying to Conceive: Myths and Truths

by Marjorie Greenfield, M.D.
reviewed by Laura Jana, M.D., F.A.A.P.
Chance plays a major role in determining when you get pregnant. On average, if the sperm arrive when the egg is ready for fertilization, only about 30 percent of women will miss their next menstrual period and have a positive pregnancy test. The remaining 70 percent, despite doing everything right, will have to wait and try again. When you're trying to become pregnant, these odds can seem just fine if you are in the 30 percent group and conceive within the first few months, but it can be very frustrating if your number doesn't come up.

Rumors abound as to when is the best time in a woman's cycle to conceive, how frequently a couple should have intercourse, which sexual practices and positions are most effective, and whether it decreases your odds of getting pregnant if you stand up immediately after intercourse. Here are the facts.

Best time to conceive
Ovulation occurs 14 days before the next period comes. For women with a 28-day cycle, this is about day 14; in women with a 35-day cycle, this would be around day 21; and in women with a 23-day cycle, this might be day 9. If you have a varied number of days between periods, you won't be able to accurately predict ovulation without using additional means, such as an ovulation detection kit.

Sperm can live in the woman's body for a few days, waiting for the egg, but the egg only lives about 24 hours once ovulation has occurred. Because of this, sex a few days before ovulation is more likely to produce a pregnancy than is sex a day or two later.

Frequency of intercourse
In couples with normal fertility, how often they have sex isn't important as long as the sperm are there in time to meet up with the egg. That said, maximal sperm counts are seen with ejaculation at 24- to 48-hour intervals, so 'saving up' sperm for the big occasion probably won't help and may actually decrease your chances of conception. In general, couples should have sex at whatever interval feels right to them (which may be once a day or once every few weeks), with extra attention given to having sex at least every other day around ovulation time.

Sexual practices
There is no evidence that one position for intercourse is better than any other, as long as the penis is inside the ****** during ejaculation. Female orgasm probably has no significant role in conception--it neither helps nor hinders the sperm meeting up with the egg. Some lubricants used for sex can kill sperm, so if you are using a lubricant, make sure it's nontoxic. One other interesting issue: The testes hang outside the body because sperm number and motility are higher at cooler temperatures, so taking a hot bath before trying to conceive probably doesn't help a man's chances and may actually temporarily diminish his fertility.

Moving around afterward
Many women worry that because semen often runs back out of the ****** after sex, there won't be enough sperm left inside to fertilize the egg. Amazingly, sperm are already in the cervix moments after ejaculation. No evidence has been found to show that lying with legs or hips raised after sex improves fertility.

You'll probably want to avoid douching immediately after intercourse, however, since douches may be mildly toxic to sperm

The best ways to get pregnant:

For some women, conceiving can be as easy as tossing out their contraception, whether they’re working on their first baby or their fourth. For others, reaching the goal of fertilization becomes a nightly chore, a mad mating dance that revolves around ovulation kits, specific sexual positions, and, more and more commonly, a succession of fertility tests to help pinpoint possible problems.

Whether you’ve just started trying to become pregnant or have been at it for a while, heeding some commonsense advice that’s based on good science can help boost your odds of conceiving. Here, noted fertility experts from around the country have outlined the do’s, don’ts, and don’t-bother-withs of getting pregnant.

Marisa Fox writes about health for national magazines.


Helping Sperm Meet Egg
Have sex frequently. It may seem like a no-brainer, but given many couples’ hectic schedules, it’s easy to overlook this one. If you’re not timing your cycles or you have irregular periods, you can cover your bases by having sex every other day, say fertility specialists.

Figure out when you ovulate. Women with very regular 28-day cycles can just count 14 days from the first day of their period to determine their ovulation date. If your cycles aren’t regular (or even if they are), an ovulation kit can help you pinpoint your most fertile time.

Most ovulation kits measure the level of luteinizing hormone (LH) — one of the hormones that signals the ovaries to release an egg — present in your urine. LH begins to surge around 36 hours before you ovulate, but most kits don’t detect it until 24 hours prior. A woman with a 28-day cycle should start testing her urine on day nine or ten after the start of her period so she doesn’t miss her surge.

A new palm-size, electronic device called ClearPlan Easy measures LH and estrogen levels, and can signal ovulation up to five days in advance.

Monitoring cervical mucus is another way to track ovulation. 'It’s not as reliable as a kit,' says Sandra Carson, M.D., professor of ob-gyn at Baylor College of Medicine, in Houston, 'but it doesn’t cost anything.' This method involves checking your secretions for a few months until you notice a pattern. Estrogen causes mucus to thin after your period, while rising levels of progesterone right after ovulation make it thicken. Once you pinpoint when you ovulate, you can plan to have sex several times leading up to that day.

The drawbacks: Many women find this method inconvenient, or inaccurate since such factors as nursing and antihistamines, even fertility drugs, can dry up mucus.

Charting your basal body temperature is useful for figuring out when you ovulate. 'Your temperature usually dips by half a degree 24 hours before you ovulate; then it goes up as you ovulate,' says Pette Zarmakoupis, M.D., an ob-gyn and director of the Kentucky Center for Reproductive Medicine, in Lexington. But since basal body temperature can be thrown off by a number of things, such as illness, don’t rely on it alone.


Step up sex before ovulation
As soon as you pick up a hormonal surge, have sex that day, plus the next two days. Pregnancy rates peak two days before ovulation, says Clarice Weinberg, Ph.D., chief of biostatistics at the National Institute of Environmental Health Sciences. Some experts speculate that’s when cervical mucus is at its optimum for helping sperm travel to the egg and break down its shell-like coating.
Sperm can live inside the uterus for 24 to 48 hours, which means there will be plenty on hand to greet the egg once ovulation starts.

Another reason to have sex before you ovulate, as opposed to the day it happens: An egg survives for only 12 to 24 hours after ovulation, so if you begin to ovulate in the morning and wait until nighttime to have sex, the egg may lose its viability by the time the sperm gets to it. In addition, says Dr. Zarmakoupis, cervical mucus starts to become thick and impenetrable right after ovulation, rendering it 'hostile' to the passage of sperm.

Enjoy yourself. 'The most important thing to remember is to keep sex fun,' says Felicia Stewart, M.D., coauthor of Understanding Your Body: Every Woman’s Guide to Gynecology and Health. When it becomes a chore, it’s easy to view sex as just one more item on your to-do list.

Give it time. Barring fertility problems and other conditions or habits that can interfere with conception, half of all couples get pregnant within six months, says Dr. Stewart, and 85 percent do so within a year.


Pregnancy Preventers
Having frequent sex or knowing when you ovulate won’t help if one of the following is working against you or your partner:

A Bacterial Vaginal Infection
A ******l infection, which may have no symptoms, creates a hostile environment that can kill sperm. And some ******l infections can cause scar tissue to form inside the fallopian tubes, which interferes with fertilization. To rule out infection or a sexually transmitted disease, talk to your doctor about having a cervical culture before you try to conceive. Your partner should be tested for testicular infections, as well as STDs.

Herbs
Taking large doses of St. John’s wort, echinacea purpura, or ginko biloba over long periods may damage sperm, according to a recent report in the journal Fertility and Sterility. (Since the testing was done on hamster sperm, further research involving humans must be done to confirm these effects.)

Stress
Studies have shown that severe stress — brought on by losing a loved one or being fired from your job, for instance — can contribute to missed periods. As for the daily pressures we encounter at home and work, fertility experts suggest finding ways to channel stress — such as through regular exercise and good nutrition — before it interferes with sleep, appetite, and your ability to function.

Obesity
Extremely overweight women (those who weigh more than 30 percent above their ideal body weight) may suffer from irregular periods.

Low Body Weight
Women who fall 30 percent below their ideal body weight may also suffer from irregular periods, and some stop ovulating altogether. Often, your period will return if you eat more and exercise less.

Smoking
The toxins in smoke can lower sperm counts or make the sperm sluggish, says Panayiotis Zavos, Ph.D., a professor of reproductive physiology and andrology at the University of Kentucky, in Lexington. To make matters worse, one study showed that smoking can decrease a man’s desire; therefore it can take a smoker up to 7 months longer to conceive.

Alcohol/Drug Abuse
Heavy drinking can prevent erections and contribute to a diminished sperm count. Zavos advises his male patients not to drink more than two glasses of wine or liquor or three glasses of beer a day.

Marijuana
use has also been linked to lowered sperm count.

Douches, Lubricants, And Soap
Anything that is introduced in your cervical canal during or immediately following intercourse has the potential to kill sperm. This is true for douches, commercial lubricants such as K-Y jelly, and even plain old soap. While soap won’t kill all of the sperm, if you shower immediately after sex, don’t use it in the ******l area.

Overheating
Men trying to conceive have traditionally been told to steer clear of hot tubs, saunas, and steam rooms and to avoid wearing tight-fitting briefs, in order to prevent their sperm from overheating. 'The testes are supposed to be five degrees lower than a man’s body temperature,' says Zavos, so avoiding situations where a would-be father might heat up for prolonged periods is probably not a bad idea.


When To See a Doctor
If you’re 35 or older, and have been trying unsuccessfully to get pregnant for six months (a year if you’re younger), see your ob-gyn, who may recommend a specialist.

Reasons to see your doctor before this: You have a history of miscarriage; have suffered from pelvic infections; have irregular periods, uterine fibroids, or endometriosis; have used an IUD; or have been treated for an abnormal Pap smear.

Fertility testing can take months to complete. First, you and your partner will be checked to see whether you’re producing and releasing eggs, and if he’s producing sperm, and how much.

From there, the specialist will try to determine whether you have an open pathway in your reproductive tract that allows sperm to travel to an egg. This test is done by injecting a liquid dye into your uterus that then travels through the fallopian tubes. Your doctor views the dye on an X ray, which allows her to spot any blockages, such as those due to fibroids. Called a hysterosalpingography (HSG), this procedure is done following a period.

A postcoital test, performed as close to ovulation as possible, is done within two hours after intercourse to make sure there’s sperm present. If your cervical mucus is too thin, you may need treatment.

A blood test taken 5 to 10 days following ovulation will measure progesterone levels to see if you have ovulated.

Some doctors may also recommend an endometrial biopsy. Done just prior to your period, it checks that you’re ovulating and that your uterine lining is growing and shedding according to schedule.


Conception Myths
'Certain sexual positions increase your chances of conceiving.'
There’s no research to show that one sexual position produces more pregnancies than another, says Felicia Stewart, M.D., of the Henry J. Kaiser Family Foundation. 'No matter what the position, sperm can be found in the cervical canal within seconds after ejaculation,' she says. 'But still, it can’t hurt to get the sperm close to the cervix using positions that permit reasonably deep penetration, like the missionary.'

'Lying still after sex helps the sperm travel to the egg.'
Since sperm can be found in the cervical mucus within seconds of ejaculation, there’s no need to lie mummylike or even to prop your legs up on pillows afterward.

'Sex every day is the ideal.'
Statistically, your chances are better if you engage in daily sex than if you settle into an every-other-day pattern. But the odds aren’t that much better — 0.37 versus 0.33. So you needn’t feel pressured to perform every night.