In more ways than one, the emotional traumas associated with infertility are well known especially to those who have been waiting for long to have children. While increased availability of counseling and support networks has attempted to understand and meet the needs, there are instances in which some of the most intimate problems couples encounters are still poorly discussed, because of embarrassment, lack of knowledge or maybe simply because of a lack of time.

Talking about sexual problem is always the best place to start. Usually, open discussion between the couple will find a solution but this is often a very difficult subject for many people. Just finding the right words to use can be confusing. Yet there are several pertinent questions related to sexual intercourse and its relationship with infertility. We will be discussing some of these today.

Making love can become an ordeal for a couple that has been trying very hard to conceive for quite a while. As man and wife, this couple has tried almost everything including scheduled sexual encounters all for the purpose of achieving a successful pregnancy. Lately however, this couple has discovered that the sexual act has become no more than a mechanical activity more for the benefit of achieving a particular objective rather than to fulfill any sexual desire. Both discovered they no longer had any sex drive or the kind of passion they used to have for each other. So what has gone wrong?

The answer is quite simple. Love making may become disappointing when a couple that is trying to conceive feels that the purpose of sex is simply for pregnancy and when this is not readily achieved the whole purpose of making love becomes a failure. It is not surprising therefore that infertility can have a devastating effect on the sexual relationship of such couples. However, it must be remembered that sexual relationship has other benefits. Not only does making love have an immediate physical pleasure, it also provides a physical closeness which gives the comfort and support which is essential for all relationships.

It is often very difficult to preserve these other pleasures when life is dominated by the desire to conceive. Once it becomes realized that it is as a result of the intrusion of having “sex on demand” that has challenged the intimacy in the relationship, the problem is half solved. Once a couple no longer takes time to enjoy sex like before, this kind of scenario is bound to crop up.

What Couples Can Do
What can be done in this situation is for the couple to learn to spend time together and refocus attention on each other. Things like going out to dinner, sharing a bath or going shopping together will go a long way to help.

The main thing that needs to be done is for such couples to learn to redirect their attention to sex, by rediscovering their bodies and renewing each other’s sensuality. They can then be reconnected to this sensuality by spending more private time together. The quality time together, should be refocused on the relationship and not conception. Only then will the desired passion be restored. Some couples want to know if they are doing the “act” right. They ask if there is any way that their chances of conceiving can be improved by changing their way or style of making love. Actually, there is no evidence that altering the position of love making or adopting any specific position ultimately has any beneficial effect on the chance of pregnancy. The point really is that as long as the semen reaches the vagina, there is always a chance of pregnancy. It’s not uncommon for semen to retract from the vagina after intercourse as is witnessed in some instances, but this does not usually indicate any problem.

One way of confirming if the semen is reaching the womb is through the post coital test. It is similar to a smear test and involves an internal examination few hours after intercourse. However, it may be too embarrassing for most couples and is not routinely advised, more so as it does not often help to decide which treatment may be indicated. When should we make love? Several couples have asked me this question. Since women are only fertile for about 24hours each month, it is advisable to make the best use of this period, but this is not to say sexual activity should be concentrated only at this time. Attempts to determine the fertile time are not always accurate and avoiding sex at other times could actually prevent a pregnancy by missing the best time for conception.

When Is The Best Time To have Sex?
As a general guide, a woman will ovulate and be fertile about 14 days before her expected period. To calculate this time, subtract 14 from the number of days between the start of one period and the start of the next. The resulting number will be the number of the day after the start of the period when the egg will be released. What this means is that assuming there are 33days between each period the egg is released on 33-14= 19 days from the start of the period. At this fertile time there will often be a change in the mucus which comes from the vagina. The mucus becomes clear, similar to egg white. This would be a good time to make love if not the best.

The frequency of lovemaking is another major factor. There are many beneficial aspects of making love apart from the fertile period so essentially, it is good to make love as often as desired. I usually tell couples that it is not a good idea to wait until the woman’s fertile period because it can easily be missed. More importantly, a long period of abstinence whilst waiting for the right day, can result in a reduction in semen quality and this has potential of decreasing the chances of conceiving. There is also no harm in making love very frequently as long as it is what both man and woman want, but it is unlikely to increase their chances of conceiving.

As a general rule, it should be noted that sperm can remain active within the woman’s tubes for at least 3-4 days after sex. Therefore, making love about twice to thrice a week will ensure that sperm are available most of the time and will give the best chance of conceiving.

Investigations for infertility are necessary and in most cases do not last for long. Many couples complain that they find the process of being “investigated” intrusive and that they feel as if someone is watching them all the time. The stress of this often causes conflict which may be reflected in the sexual relationship. But then, finding a cause for the infertility is also finding “blame” and “fault”. If a cause is found that means there may be no chance of conceiving, there may then seem to be no reason to make love any more.

The only time a couple may be asked not to make love is usually before the test to check the fallopian tubes either through an operation or an x-ray test. This is necessary to ensure the woman is not pregnant when these tests are done.

Most couples always want to know if their lovemaking can continue during treatment. Generally it is advised that the couple should continue with normal sex during treatment, although this may be difficult if drugs have been given to stimulate the ovaries as there may then be some discomfort. There is no evidence that making love before or after treatment such as IVF will reduce the chances of pregnancy. However, many couples find the stress of the treatment overwhelming and sex therefore often avoided at this time. Some treatments will require lovemaking at specific times e.g. after drugs to induce ovulation, and to abstain beforehand for a few days. This would be further explained at the clinic.

Some couples are unable to have full intercourse because of psychological problems and this is usually best helped by seeing an appropriate counselor. Others may have physical problems which cannot be corrected by surgery or drugs. If a semen sample can be produced, it is possible to identify the fertile time and artificially insert the semen into the vagina then. Often this can be done at home but the clinic should be able to give appropriate advice.