Ideal Sexual Frequency
There has been no research-based consensus among fertility doctors (reproductive endocrinologists or REs) regarding sexual frequency when couples are trying to conceive a baby — whether they are undergoing fertility treatments or trying on their own. The general thinking for years has been that during the seven to 14 days before ovulation, ejaculation every two to three days results in both good sperm production (sperm counts) and motility.
Most fertility doctors will then recommend couples having sex every other day around the suspected time of ovulation (mid-cycle) if couples are not monitoring a cycle with an ovulation predictor kit (OPK). If couples are using an OPK for monitoring the luteneizing hormone (LH) surge, or an hCG injection to induce ovulation, having intercourse on the day of ovulation (or just before) offers the highest chance of pregnancy.
Reactive Oxygen Species (ROS) vs. Antioxidants
Recent scientific evidence has revealed that a condition known as “oxidative stress” may be a factor in some of the causes of male factor infertility.
Reactive oxygen species (ROS), also referred to as “free radicals,” are chemically-reactive unstable molecules containing oxygen. ROS forms as a natural byproduct of the normal metabolism of oxygen. Free radicals/ROS are produced through a number of normal internal functions of the body, but may increase when the body is subjected to various conditions, especially certain toxic environmental exposures; for example, heat. ROS/free radical levels can increase dramatically, resulting in significant damage to cell structures. Harmful effects of ROS on the cell most often result in damage of DNA.
Spermatogenesis is a process that takes several months for each sperm to be produced in the testicle, and then stored in the epididymis. The epididymis, abundantly rich in various antioxidants, such as Vitamins C and E, plays a major role in shielding sperm from damage from free radicals/ROS and other forces during storage.
Australian Study: Sperm Quality Increases with Frequent Sex
David Greening, M.D., an Ob/Gyn and reproductive endocrinologist at Sydney IVF in Australia believes that frequent ejaculation might be a physiological mechanism to improve sperm DNA damage, while maintaining semen levels within the normal, fertile range. To investigate this hypothesis, Dr Greening studied 118 men who had higher than normal sperm DNA damage as indicated by a DNA Fragmentation Index (DFI).
The fertility researchers found that daily sex (or ejaculation) for seven days improved men’s sperm quality by reducing the amount of DNA damage. Dr Greening said the reason why sperm quality improved with frequent ejaculation may be because the sperm had a shorter exposure in the testicular ducts and epididymis to reactive oxygen species/free radicals.
This study showed that frequent sex (daily) decreased semen volume and sperm concentrations, but improved sperm motility and decreased sperm DNA fragmentation. It is important to note that this study evaluated sperm parameters, but not pregnancy rates.
Will Improved Sperm Quality Result in Better Pregnancy Rates?
Further research is required to see whether the improvement in the sperm quality due to more frequent ejaculation translates into higher pregnancy rates, but other studies have shown a positive relationship between less sperm DNA damage and better pregnancy rates.
In couples who have failed multiple cycles of IVF, using testicular sperm during a subsequent IVF cycle has lead to better pregnancy rates in several studies and provides a new option in these selected patients.
These studies provide the rationale for my treating male infertility with innovative, inexpensive options — combining high levels of antioxidant supplements and more frequent ejaculation leading up to artificial inseminations or IVF. The men should have daily ejaculation/sex for seven to 10 days leading up to artificial insemination/IVF, but abstain the night before. If excessive free radicals/ROS lead to sperm DNA fragmentation and damage, and if antioxidants and frequent ejaculation can neutralize or reduce oxidative stress in the semen, then it would make sense that male supplements containing vitamins, minerals and antioxidants combined with more frequent ejaculation may improve sperm quality and lead to better pregnancy rates.