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Deborah Howell (Host): You know, going through fertility treatment is an exciting and hopeful time for everyone involved, but there are so many questions around it for women, as well as men. Joining us today is Dr. Asima Ahmad, a Reproductive Endocrinologist at Fertility Centers of Illinois, and she's here to answer your questions.   This is The Time to Talk Fertility podcast. I'm your host, Deborah Howell. Dr. Ahmad, here's the first of 21 questions about infertility submitted by our listeners for you. How often should you have intercourse when trying to conceive?

Asima Ahmad, MD Guest): Thank you for having me. And I'm really excited about these 21 questions. So, for this one, I think the way to think about it is in the sense of the timeline of the egg and the sperm. So, when you ovulate those eggs last 12 to 24 hours, and the sperm inside the female body lasts about three to five days. So, if you expect to ovulate about five days from now, you can start having intercourse today. Skip every other day, if you'd like, and then include the day of ovulation and the day after. And that should cover you.

Host: Going to need spreadsheet.

Dr. Ahmad: I mean, I guess you could have intercourse every day, but sometimes, you know, it can be a bit much, so.

Host: There you have it now, what should I do if my partner can't ejaculate or achieve an erection?

Dr. Ahmad: There can be many reasons for this. And I think the first thing is to determine why it's happening. For instance, is he never able to have an erection or ejaculate, or is it under certain circumstances around, for example, the time of ovulation and this happens pretty frequently. Sometimes it can also be related to hormones. Whereas other times it could be something else, like stress. So, it's always good to have an idea of you know, when this is occurring, if it's occurring all the time and that way you can discuss that with your doctor or even see a male fertility specialist called a urologist to determine the cause.

Host: That's fair enough. Why is sex so painful for some couples?

Dr. Ahmad: To start off, it shouldn't and again, it goes back to the importance of figuring out why it's happening. Things that can help determine the cause are thinking about the following, is it all the time or is it just occasionally? Is it related to certain positions? Is it more around the time of your menses or period? And has it always been painful or is it only recently? So, some reasons could include endometriosis, vaginismus, which is tightening of the vaginal muscles upon penetration, previous vaginal injury, or even vaginal dryness.

Host: Okay, well, so that would lead me naturally to my question. Can we use lubricant during sex?

Dr. Ahmad: Yes, there are some lubricants that you can purchase that were made specifically for those trying to conceive. Some of those are PreSeed, Conceive Plus, and a few other brands. Also sometimes you can try items at home such as canola oil, but always check with your provider before trying those.

Host: All right. And now is one sexual position better to get pregnant?

Dr. Ahmad: No, but you do want to pick a position that is comfortable for both you and your partner, because the most important part is to try to optimize ejaculation inside the vagina.

Host: So, no hanging from the chandelier when you're trying to do this.

Dr. Ahmad: Not necessarily no.

Host: All right. Now is one sexual position better for having a boy or a girl?

Dr. Ahmad: No, there's no data to support position and trying to have one sex or the other.

Host: All right. That's one myth busted. Does extra weight hurt our fertility?

Dr. Ahmad: You know, extra weight, especially those who are obese, so, having a BMI over 30 can impact fertility in different ways. One way is that it can decrease the egg quality, but it can also make your cycles irregular. Not only that, it also increases the risk for pregnancy complications such as increased risk for gestational diabetes. So, it's a good idea to get into a healthy weight range to not only increase your chances of getting pregnant, but also reduce the risk of complications for you and the baby during the pregnancy.

Host: Okay, this is a very interesting question that was submitted. Will I be more likely to get pregnant if I have an orgasm?

Dr. Ahmad: Very interesting question. And I wish I had a very interesting answer, but the answer in short is no, it does not increase your chances pregnancy.

Host: But it doesn't decrease them either.

Dr. Ahmad: It doesn't decrease them either.

Host: Okay. Sounds good. Can we have too much sex when trying to conceive?

Dr. Ahmad: In most cases, no. Having intercourse every day around the time of ovulation is okay for most couples. In some cases, when there's an abnormality with sperm, such as low sperm counts, your doctor may advise you to space out intercourse to every other day around the time of ovulation. I would make sure that when trying to conceive, that you also try to make sure that you're not having too much stress around the process of intercourse. You're having sex. You're trying to have a baby. It's a beautiful thing. So, don't feel too much that you have to have intercourse multiple times in one day or to the point that it becomes more stressful than anything.

Host: Okay. And on the flip side, can I get pregnant if we only have sex once or twice a month?

Dr. Ahmad: It is possible, but it would have to be timed appropriately again, to line up with your ovulation because of that timeline of the egg only lasting 12 to 24 hours. Again, the sperm can last three to five days. So, if intercourse occurs within that five days of ovulation, it is possible.

Host: Okay. How about will saliva kill sperm?

Dr. Ahmad: Okay. So, if a man has normal sperm counts, saliva will likely have no impact on affecting it. There are some studies that indicate that large amounts of saliva may impair sperm movement or motility, especially in those with low sperm counts. But overall it should be okay.

Host: Okay. Now I have a feeling you're going to bust another myth on this one. Will having an orgasm cause a miscarriage?

Dr. Ahmad: So, if you have a normal pregnancy without complications, then having intercourse or orgasm, shouldn't increase the risk for miscarriage. However, if you are someone with complications, please check with your provider to make sure it's okay. And it's not just the orgasm, but just having intercourse in it of itself.

Host: Infertility as you've mentioned, can be stressful. What can couples do to alleviate stress?

Dr. Ahmad: Good question. Many things then of course, for every individual, what you find relieve stress may be different. I always start with recommending exercise and being more active because increased activity can release endorphins in your body, which also improve your mood. And it's also good for you. So, it's like two birds with one stone, though I'm sure some of us find the thought of doing exercise stressful in and of itself. Other things could also include spending time with your loved ones, cooking, meditating, acupuncture, or sometimes just me time.

Host: For sure. I'm with you on the exercise though. I mean, you just feel so much better mentally and physically afterwards. Now does the amount of ejaculate predict a man's fertility?

Dr. Ahmad: In a way, yes. If his volume of ejaculate is very low, it will lower his total motile count. So, total motile count is the total number of motile or moving sperm in the ejaculate. And it's calculated by multiplying the volume of ejaculate by the concentration of sperm by the motility or the movement. So, when one of these items is low, like the ejaculate volume, it will reduce the total number of moving sperm in the ejaculate overall. So, you ideally want to have a total motile count of over 20 to 4 million for timed intercourse, to be safe.

Host: I always found it so interesting that the sperm is one of the very smallest cells and the ovum is one of the largest, right?

Dr. Ahmad: Yeah, that's very interesting.

Host: It's a, yeah. What a creation. Anyway, can you, prescribe us Viagra? I'm sure you get that a lot.

Dr. Ahmad: So, as a physician, of course I can. But before prescribing the Viagra, I always think it's a good idea to figure out why the erectile dysfunction is occurring. And for that, I typically co-manage your case with a male fertility specialist or a urologist. The urologist is likely going to do a physical exam and hormonal testing to determine the root cause of erectile dysfunction. Because again, going back to you want to make sure that you're treating the cause properly.

Host: Here's another question from a listener. We have experienced multiple pregnancy losses. Should we consider a gestational carrier?

Dr. Ahmad: So, I think it's important again, to have this discussion with your provider and preferably a specialist in recurrent pregnancy loss, such as a Reproductive Endocrinologist. It's important to determine why you have had multiple losses. In some cases, it will be something that you can treat and after treatment you'll be able to carry your next pregnancy to term without complication. But if you've already completed the full workup and despite all this, you're continuing to have losses in some of those cases, yes, you may consider using a gestational carrier.

Host: Now that I'm pregnant when can we have sex again?

Dr. Ahmad: This question comes up a lot. In most cases, yes. But again, in the case of ongoing bleeding or pregnancy complications, it might be best to hold off. I would, in those cases, check with your provider to make sure it's okay.

Host: Okay. I like this next one. My husband has low sperm count, but takes fish oil and CoQ10 supplements. Can he use a hot tub?

Dr. Ahmad: So, he's doing something great for sperm, but yes, using a hot tub is not so great. If you're trying to conceive, I would recommend not using a hot tub because increased heat to the testicles can impair sperm production and function.

Host: My sister was married to a pilot and he used to sit in that cockpit in the sunshine waiting to take off. And it was like a hundred some degrees in there and they were wondering why they were having trouble conceiving. And that turned out to be the problem.

Dr. Ahmad: Oh, goodness.

Host: So not just hot tubs, you know, stay out the cockpit.

Dr. Ahmad: I mean, yeah. Anything, even getting really high fevers, you know, that can do it as well.

Host: Okay. I know you're hot blooded, but you got to cool down guys. Now, how do you increase your libido?

Dr. Ahmad: There are many ways, but again, it's important to determine the cause of why you have a low libido. Has your libido always been low or is it more recent? And if it is recent, is it due to new stressors in life, lack of sleep and exhaustion, a new partner or even hormones. And then again, once the cause is determined, it'll be easier to focus on treating the libido.

Host: Okay. The final three, here we go. Does evening primrose oil help with conception?

Dr. Ahmad: So, the oil that's extracted from the evening primrose plant, it contains omega six and omega three fatty acids. So, some say that those two things can reduce inflammation or assist with optimizing cervical mucus. However, having reviewed multiple studies, there's no high quality studies that have proven a true benefit from using evening primrose oil and increasing fertility. More than that, there are good studies, linking fish oil and egg quality. So, if you're interested in taking a type of supplement, that's similar, I would recommend the fish oil over the evening primrose oil.

Host: Got it. In a natural FET cycle, can it be canceled because progesterone is too low before suppositories?

Dr. Ahmad: So, I think this depends on your doctor and your protocol. In some instances yes. But in others, your doctor may continue the cycle with progesterone supplementation to bring up and keep that level of progesterone high to support the pregnancy. In other instances, when the progesterone is low due to lack of ovulation, the doctor may consider cancellation and switching to a different protocol altogether, either to optimize your ovulation the next time around, or even a different type of program cycle protocol, which does not require ovulation to take place at all.

Host: Got it. Finally, can you share some words of hope with our listeners, Dr. Ahmad?

Dr. Ahmad: Absolutely. Yes. You are not alone and you will get through this. And you have a whole community of support around you. And this is what National Infertility Awareness Week is all about. Please do not hesitate to reach out with questions, or if you need assistance. There are many people out there that have gone through either something similar to what you're going through or are here to help.

Host: Well, Dr. Ahmad, we can't thank you enough for being with us today. It was inspiring, fun and very interesting.

Dr. Ahmad: Thank you for having me. I had a great time.

Host: That was Dr. Asima Ahmad, a Reproductive Endocrinologist here at Fertility Centers of Illinois. Call (877) 324-4483. Or visit us online at fcionline.com to schedule a Telemedicine consultation with one of our wonderful physicians. And if you enjoyed this podcast, you can find more like it in our podcast library, and be sure to give us a like and a follow if you do. This has been The Time to Talk Fertility podcast. I'm your host, Deborah Howell. Have yourself a terrific day.