There is a lot of confusion about when, during a woman’s cycle, is the best time to try to conceive (TTC). The confusion arises from: a lack of understanding on how long an egg can survive after ovulation if not fertilized, how long sperm survive in the woman’s reproductive tract, and more basic, how to know when ovulation takes place. When these three pieces of the puzzle are more clear, understanding when to TTC becomes easier.
How to know when someone is ovulating?
Ovulation is basically when a matured egg is released from one of the ovaries. As the egg in the follicle begins to grow due to the hormone FSH (Follicle Stimulation Hormone), the follicle begins to secrete estrogen (estradiol). The pituitary gland in the brain is monitoring the amount of estrogen being released by the follicle and once there’s enough estrogen, the brain then produces a surge of another hormone, luteinizing hormone (LH), and forces the egg out of the follicle. After the egg is released, it moves into the fallopian tube and it waits to be fertilized by a sperm. Understanding when ovulation takes place is crucial for knowing when to TTC. The changes in hormone levels during ovulation will typically manifest in a few physical changes that can be helpful to identify when ovulation will take place. Here are a few signs to look for:
The most common, and useful for the sperm, is cervical mucus (CM). A few days before ovulation this fluid will have the consistency of egg whites – clear, stretchy, slippery and without odor. Typically appearing on an average of 4 days before ovulation, CM indicates the beginning of the “fertile window” - telling the couple that it is time to TTC. In addition, CM not only makes it easier for the sperm to swim up the vagina, but also its composition protects the sperm - increasing their lifespan inside the female reproductive tract. As soon as the CM changes to this clear, stretchy and slippery consistency it means that ovulation will soon take place and it’s time to TTC.
As mentioned earlier, as the egg in the follicle grows, the levels of estrogen rises. This increase of estrogen in the body causes breast tenderness. Since after ovulation estrogen levels drop and progesterone levels rise -also creating breast tenderness, it is a good idea to use breast tenderness as another sign (i.e. CM) when trying to predict ovulation.
Nature wants us to procreate so during ovulation the body increases the amount of luteinizing hormone (LH), giving libido a boost. Not only spiking the sexual desire of the woman, but the man is likely to feel more attracted to his partner. An increased libido is a clear sign that ovulation is coming soon and the time TTC is now.
How long does the egg live?
The egg will die (and the body will absorb it) if not fertilized between 12 to 24 hours from the time that it was released from the ovary. For the first step of pregnancy – fertilization, the job of the woman is done once she releases that egg. It is now up to the man to release a strong enough sperm that can swim all the way up to the fallopian tube and fertilize the egg before it expires. Which brings us to the next question:
How long can the sperm survive in the female reproductive tract?
The most accepted number is 5 days, although there are a few studies showing less days and one study showing a few survivors after 6.8 days. There are several factors that contribute to how long the sperm survive. The acidic nature of the vagina, the response of the woman’s immune system (the sperm is a foreign organism), and of course, the health of the sperm, are at the top of the list. While the woman’s CM can help with the acidic environment of the vagina and provide a more friendly environment, sperm have to be in the lookout for hungry phagocytic leukocytes that want to protect the woman from these invaders (sperm). The speed of the sperm becomes crucial for their survival.
Best time to TTC
While it is very possible to conceive if a couple TTC during ovulation, the risk is too high and every expert on the subject will recommend not to wait until ovulation to TTC. There are many studies indicating that most women get pregnant with 2-day old sperm and older. A paper released by the British Fertility Society where they summarized the findings of a study done by Demographic Research, titled “Daily Fecundability”, concluded that almost 90% of women get pregnant with sperm that is at least 2 days old. The study also showed that 26% got pregnant with 2-day old sperm, 24% with 3-day old sperm, and only 10% got pregnant when couples TTC on the day of ovulation. Similarly, a study done by The New England Journal of Medicine where the aim was to see if the timing of sexual intercourse in relation to ovulation had any influence on the chance of conception, concluded that:
“Among healthy women trying to conceive, nearly all pregnancies can be attributed to intercourse during a six-day period ending on the day of ovulation”
How often to TTC and men's health
TTC every day during the fertile window could be stressful for some couples. Men with a healthy sperm count and motility can afford to TTC every other day. A study published by The New England Journal of Medicine didn’t see a big difference between TTC every day versus every other day, 25% chance of getting pregnant and 21% respectively. On the other hand, men with low sperm count can benefit from TTC every day. In fact, TTC multiple times a day has shown to increase sperm count on men with low sperm count. A study published by Fertility and Sterility titled: “How often should infertile men have intercourse to achieve conception?” looked at the semen analysis results of men ejaculating twice in a 1–4 hour period. The study found that, in contrast to men with normal fertility, men with low sperm count had no significant difference in the number of sperm produced in the second sample. The study concluded by saying that:
“Most of these infertile men may significantly increase their fertility potential, assessed by the total motile sperm counts, by having intercourse every day or even twice a day"
Another study published by Reproductive Biomedicine had a similar conclusion. The study done with 73 sub-fertile men, titled “Semen characteristics in consecutive ejaculates with short abstinence in sub-fertile males”, concluded that: “Semen characteristics were compared between initial and consecutive ejaculate showing improved semen parameters: progressive grade A spermatozoa, morphology and sperm concentration”. Several theories are behind these results, but one that makes the most sense is that men that don’t ejaculate often have more dead and more badly shaped (morphology) sperm. In addition, men that don’t ejaculate often are at a higher risk of prostate cancer. A study published in 2016 by European Urology, a peer-reviewed medical journal covering urology, concluded that:
“Evidence suggests that ejaculation frequency may be inversely related to the risk of prostate cancer"
Acupuncture and sperm & egg quality
While many factors can affect the quality of sperm and egg, insufficient blood flow is one of the leading causes. The ability of acupuncture to improve blood flow, and as a result increase sperm and egg quality, has been shown time after time. A study titled “Effect of Acupuncture on Sperm Parameters of Males Suffering from Subfertility Related to Low Sperm Quality”, published by Systems Biology in Reproductive Medicine, mentioned that the fertility index increased significantly in the group that received acupuncture (percentage of viability, total motile spermatozoa per ejaculate, and integrity of the axoneme). The study concluded by saying that:
“Thus, patients exhibiting a low fertility potential due to reduced sperm activity may benefit from acupuncture treatment"
A very recent study was done in China in April of 2023 to observe the effects of electroacupuncture on ovarian reaction, egg and embryo quality, as well as pregnancy rate. The study concluded that:
“Electro acupuncture can increase the ovarian reserve, reduce the serum FSH level, and improve the quality of eggs and embryos. This therapy tends to improve the clinical pregnancy rate and clinical pregnancy outcome."
The best time to start TTC is about 5 days before ovulation. Men with normal fertility could afford to have intercourse every other day, but sub-fertile men should have intercourse every day. A lot of the times the quality of the egg and sperm diminish due to a lack of blood flow to the entire reproductive system. Acupuncture has been shown to improve blood flow in the reproductive organs and help with fertility.