Intercourse Frequency -- Why more might be better

[I hadn't posted this info before and I want to get it out there. I know its not entirely topical at the moment but I hope you don't mind the diversion]

Since we have a bit of a sperm morphology issue we first tried the every other day routine recommended for MFI. But after having no success and then playing around with the numbers it seemed to us that loading up the EWCF with sperm prior to ovulation would help get more swimmers in there and ready to catch the egg. We've used this strategy both times we have gotten pregnant.

I looked up more research and articles related to ejaculatory frequency and I found some interesting things that I thought I would share:

"The characteristics were examined of 87 consecutive semen samples obtained from participants of an intra-uterine insemination (IUI) programme. The population investigated comprised 65 normozoospermic, 13 moderately oligozoospermic and nine severely oligozoospermic individuals. The samples were produced after 4 days abstinence for the first IUI and after a further day of abstinence for the second IUI. Semen volume, sperm concentration, total sperm count and total motile sperm count for the whole population decreased significantly between the first and second samples. [b]The characteristics of the second sample were significantly decreased only for the normozoospermic group.[/b]"
The effect of ejaculatory frequency on semen characteristics of normozoospermic and oligozoospermic men from an infertile population.
Matilsky M, Battino S, Ben-Ami M, Geslevich Y, Eyali V, Shalev E.
[Note: Normozoospermic is normal counts, oligozoospermic is low counts. The numbers seems to jump down more if you have normal counts -- the higher you are the harder you fall.]

"there was a significant positive relationship between the time taken to produce a specimen and sperm concentration. We conclude that the duration of preejaculatory sexual arousal is an important predictor of ejaculate quality for specimens produced by masturbation and that variation in the duration of preejaculatory arousal may contribute to within-male fluctuations in semen parameters over time."
Duration of sexual arousal predicts semen parameters for masturbatory ejaculates.
Pound N, Javed MH, Ruberto C, Shaikh MA, Del Valle AP.
[Note: we should be doing our best to get our guy intersted evidently if we want his best "effort"]

"Sperm numbers and semen volume increased with duration of abstinence. Abstinence did not influence pH, viability, morphology, total or grade A motility, or sperm DNA fragmentation. A short (24-hour) abstinence period negatively influenced chromatin quality."
Influence of the abstinence period on human sperm quality.
De Jonge C, LaFromboise M, Bosmans E, Ombelet W, Cox A, Nijs M.
[Note: Chromatin is what they are testing for in the SCSA test]

"The results have demonstrated that the motility and normal morphology of spermatozoa do not change significantly with ejaculation frequency. Also, while the volume of the ejaculate and the total number of spermatozoa decreased during a period of frequent coitus, an individual's depletion and recovery of his spermatozoal reserve could not be accurately predicted. It is suggested that coital frequency during the woman's periovulatory period could be modified by the partner's response to this test. Furthermore, while it is acknowledged that the variation in results from a 'routine' semen analysis is large, data obtained after depletion of the extra-gonadal reserve and recovery over a set time may have more value and could be the method of choice for the future."
Studies of human seminal parameters with frequent ejaculation. I. Clinical characteristics.
Matilsky M, Battino S, Ben-Ami M, Geslevich Y, Eyali V, Shalev E.

It just seems to me that the every other day BD routine might not be right for all MFI folks and that it is worth it to try upping frequency to see if it helps improve things for you. Since morphology and motility don't really necessarily seem to be affected it might be better to try out some sexy lingerie and a strip tease and learn some tantric breathing techiques to slow him down a little.

It's worth a thought.

Here's a chart showing why this might work:



I took two different hypothetical total counts and then reduced subsequent by 30%, just a random level that I pulled out of the air. Obviously real life generation rates could be better or worse than that, but note that based on this model having more sex results in a greater number of total sperm deposited.

Two other gals that I know online who were TTC post vasectomy reversal both tried this strategy and it worked for them the first try as well.

Some other random bits of info:

• The best sperm can live in a test tube at room temperature for a week
  
• it takes about 20 sperm to help weaken the zona pellucida enough to have one be able to penetrate the egg to fertiize it
  
• on the day of ovulation your body has already produced some progesterone which helps ripen the follicle. This progesterone can change the quality of your CF so that it is less hospitible to sperm so timing BD on the day of your peak day (the gooey EW day) or prior is probably the best.
  

Epididymitis

Any infection of the reproductive organs has the capability to interfere with fertility, though it looks like this infection doesn't usually lead to lasting fertility problems when it is treated but there is a chance of obstruction or antisperm antibodies.

"Unilateral or bilateral obstruction of the genital tract (either congenital or acquired), epididymitis and varicocele are also sometimes associated with an autoimmune response against spermatozoa."
from: Antisperm Antibodies

Here are some links about epididymitis, and fertility for your reference:

What is Epididymitis and how is it treated?

Epididymitis And Orchitis

Orchitis and epididymitis

bacterial epididymitis

If your partner has this infection currently or he did previously I would suggest that after treatment by a doctor (probably with antibiotics), if you are TTC he should have another S/A to make sure everything is working properly.

a post to another woman dealing with MFI...

We had REs tell us we probably needed do do ICSI as well, it was basically presented as "you can work up to it however you like but it is probably what it will take". We tried the alternative medicine route and supplements instead and I'm still in disbelief that we did it but we're in our 6th week now.

Have you consulted yet with a urologist (UR) who specializes in (male) fertility issues? Out of anyone we worked with he was great to have as a backup and he thought we could do it with my partners numbers (see my sig below) even post vasectomy reversal. Have the S/A tests included tests for antibodies, it isn't a standard test. Also, the UR had us do the SPA test to see how the sperm reacted with the egg membrane. We did that test in May, the test results came back positive and we coincidently conceived the same cycle. He felt that the SPA (sperm penetration assay -- aka hamster egg test -- poor hamster) was useful as a next step in our diagnosis.

Dr Perloe had also suggested to us that the sperm DNA fragmentation test would be worthwhile but we didn't have to go that far.

ICSI is expensive and (not to alarm you but this made me wary) might possibly damage the fertilized egg. I know we have read articles, etc. it is just that a friend of mine is a microbiologist researcher working with reproductive research and he told me that among his colleagues there was concern that this is still a new procedure and the long term risks were uncertain.

You could try IVF with rescue ICSI (just in case the sperm aren't doing their job in the dish) instead.

Go for the vitamins and exercise for your partners/husbands though -- selenium, zinc, vit.c and antioxidents. You want to have sperm that are strong and can optimize the best ones to be stronger.

We had doctors tell us along the way that SSRI meds for panic-anxiety that my partner took didn't affect fertility but when I read the fine print their tests on rats left a question mark. He got off of Paxil and his count increased.

Then they told us that morphology was something that you are born with and there is nothing to be done about it but he had a vasectomy and reversal and I found it hard to believe that might not contribute.

They also said there was nothing you could take, or do to improve MFI but we didn't give up. My partner saw a naturopath and was Dx as being hypoglycemic so he changed his diet and eating habits and he's felt a lot better since.

They told us IVF/ICSI was the only way but they would take us through a progression -- abdominal surgery for me with 3 months recovery (and 3-4 weeks missed work) before we could try again, then try naturally for 3 months, then try IUI/Clomid for 3 months and then move on to ICSI. We were devastated.

We watched and read the stories of the other couples online who succeeded in spite of similar low morphology and had hope. I noted every instance of slight improvement and finally looked up all of the anti-oxidents and nutritional supplements that people were trying. He's been taking those for 6 months and coincidently hasn't had any problems with panic-anxiety. He started walking to work each day as he was able and he's feeling great.

Then we just tried to maximize the odds (plus I did a bunch myself to improve my fertility since my fibroid was an issue as well) and kept our fingers crossed but I thought for sure it wouldn't work, we were hopeless and intervention might be the only way. But then my period was late and my breasts were large, my body was hot and I took the test and we got our first positive pg test.

I'm feeling pretty good so far. My PMS is enough to contend with and this seems a lot easier to deal with -- just feeling a little queasy (almost barely) and then there are I guess some light cramps. My breasts are a little fuller but you would have to be intimate with them to notice, they actually hurt less than they did last week when I was PMS-ing.

Honestly for those of you who haven't been pg before it isn't earth shattering necessarily (which in my head it always seemed like it was). It is like a natural progression of the menstrual cycle which I usually describe as being a test cycle each month to help things tuned up and ready to go.

I'm off to get my next blood sample. The nurses were total flakes yesterday. My doc said on Wed to call on Thursday to find out if I should do supplemental progesterone. I had to call twice and I didn't hear back until 5pm yesterday that I should but by then they couldn't call the order in until today. I've been using my natural progesterone cream in the meantime. My mother had low progesterone when she was pregnant with her first baby so I think it might be a genetic thing that we aren't such great producers of progesterone.

We'll tell one grandma over Father's Day weekend since she'll be in town (she will be so excited since my partner is her favorite and she's been wanting lots of grandkids to spoil). My parents I think I'll wait until the end of the month when I'm in New York for a family wedding.

I got my blood work back and my HCG (beta?) is 435 and my progesterone was 18.4. I'm waiting to hear if they want me to supplement progesterone but I can feel the extra hormones -- especially in my bbs which are feeling a little fuller and less sore than what I experience normally with PMS. I told you all back
when my CD21 test came back low in November that my suspicion was
that low progesterone was part of my issue. The elevated progesterone so far actually makes this pregnant part easier than my PMS -- my breasts are full but less sore and my mood is better. Normally I go from grouchy and sore to feeling hot in my lower abdomen and weak when I get my period. Are you sure my period isn't going to show up on my unexpectedly? Should I keep running around with sanitary products in my handbag?

I saw my acupuncturist this morning as well and told him that my
fibroid was smaller. I didn't tell him about the pg and asked him to
check my pulses (this is something that you have to find a good
acupuncturist to do but it is amazing what he can sense from both
wrists). He checked first on the left, then on the right and then he
looked at me and asked "are you pregnant?" I've been going for
treatment since January and it has really helped calm my system down. I tend to be a bit frenetic and very sensitive -- work and emotional stress knock me down quickly and I get sick a lot because of it. With acupuncture I feel a lot more even. We're going to give treatment a break for a few weeks while my body adjusts to the pregnancy.

Because of my fibroid and TTC I've gotten quite attuned to the
different pains and sensations in my lower pelvis. I would have
fibroid related pain on the right side, a couple inches to the right
of my belly button in a vertical channel. Last night and today I feel a sensation more in the center but just to the left of my belly
button. Not pain but something is going on in there and it feels like the front, side and back of my uterus that are involved. In
acupuncture they say that things are being reorganized.

I'm just back from the RE. He said it was too early to see a gestational sac and it is really early still. I told him that we were pleased just to see that our equipment works!!!

My fibroid was a bit smaller too no 9cm measurements this time. It was only 6x7cm.

They did a blood draw to check my progesterone and HCG. I'll have the latter in an hour or so. Progesterone will have to wait until tomorrow.

I told them that I wasn't sure if they would show me the door since we got a positive pg on our own and they said no, that's not how they work. The doc was pleased about the positive pregnancy test just by itself. I thanked him for making me feel like my fibroid wasn't a life sentence and that in that he helped alleviate my stress and that surely that influence helped out as well. He said he would happily take credit. I also asked him to please tell the UR in the same clinic (the one who did the reversal) that he had another success story.

My partner is so excited he's already telling me what to eat and not eat. Let's hope it is a keeper because we are so ready for this change in our life.

I just wanted to add that I too used every last positive posting about MFI successes to have hope even though doctors sometimes made it feel like there wasn't any reason for any. If there is anything I can do for any of you to help make you feel better supported please let me know.

Our UR didn't check for antibodies until we asked. That was frustrating to say the least since one RE (the male head of a university fertility center in our area -- who fired me as a patient b/c I didn't want to have abdominal surgery) I was talking with assumed we had an anti-body issue without any tests being done.

My partner likes to think that the doctor's know it all and I was raised to question doctor diagnoses (my dad went to medical school and was in practice as a dentist so we had a different perspective on the medical system). He's open to my research but one RE (a woman) told him a year ago in Feb that he probably always had a morphology issue and that it was genetic and there was nothing to be done about it -- yet the UR works in the same clinic and he is optimistic for us in spite of the bad morph numbers. (We don't have antibodies thank goodness -- we've got enough working against us).

Here's the fact sheet from the ASRM site about Diagnostic Testing for Male Factor Infertility

My cycle average length is 30 days but the longest one since I've been charting was 33 days. I could be hours or minutes away from it starting though. Here's to cycles longer than 30 days though.

SPA Test Results (poor hamster)

I just got off the phone with our fertility clinic and they gave me the results from the SPA test (the hamster egg test). The results were 5.8 and less than 2.x is failing. She told me that we were normal.

They didn't check morphology this time (I tell him he's got to ask for these things or else they forget) and his count is 36 million and he had 57% motility. Not too bad.

I would love to know if there was any change in the morphology due to his supplements but no such luck this time.

Then, I heard the oddest story today. This woman couldn't get pregnant and was going to have a hysterectomy (maybe for pain). Since she wanted to have a baby they did some procedure on her to remove endometriosis. She had odd adhesions maybe covering her ovaries. They cleared out the film that was blocking the passage of the egg and low and behold she got pregnant with quadruplets -- and this was totally natural, no medications. How crazy is that?

The only other boy tests I can think of us having done is the SCSA test (thanks for reminding me) which I'm waiting to hear back from the UR about, and then maybe more blood work since his FSH was a little high at last check a while back.

Here's for small blessings!