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.
  

Semen Analysis -- Helpful Details

Tapered refers to the head of the sperm, I found several references that mention testicular heat as a possible contributor to this defect:
Men with an elevated testicular temperature frequently due to a varicocele or exposure to excessive heat often have tapered sperm quality and may be missing the acrosome, the packet of enzymes at the tip of the sperm head that allow the sperm to bore through the coating of the egg.
From: An in-depth look at fertility

I also found this article: Deterioration Of Sperm Morphology In Men Exposed To High Temperature

Forward progression has to do with how well the sperm are at swimming forward. I don't know much about it but Vitamin E and Selenium are supposed to help with motility

Hypoosmolarity has to do with too much water being in the sperm cell I believe, remember osmosis from biology class in high school? I couldn't find anything that directly spoke to directly this but this quote points out some possible things to research more on:
In mammalian cells, hydration may change dynamically in response to hormones, ethanol, aniso-osmotic environments, oxidative stress or by cumulative substrate uptake.
from: Hepatocellular hydration: signal transduction and functional implications.

Here's a comprehensive guide to refer to: Semen Analysis in the Clinical Evaluation of Infertility

Semen Analysis

Here are some comprehensive guides to refer to: Semen Analysis in the Clinical Evaluation of Infertility

Semen analysis

The Fertility Guide: The Male Factor

Normal Ranges for a Semen Analysis from INCIID

Helpful Details

Morphology refers to the shape and structure of an object. Morphology may be even more important than count or motility in determining potential fertility. Abnormally shaped sperm cannot fertilize an egg. About 60% of the sperm should be normal in size and shape for adequate fertility.

The perfect structure is an oval head and long tail. Abnormally shaped sperm may include a number of variations:

A very large round head. (In one study, if 14% or more of sperm had round enlarged heads, the chances for pregnancy fell to about 20%. Such an abnormality indicates early unraveling of genetic material.)
An extremely small pinpoint head.
A tapered head.
A crooked head.
Two heads.
A tail with kinks and curls.
From Infertility in Men

Tapered refers to the head of the sperm, I found several references that mention testicular heat as a possible contributor to this defect:
Men with an elevated testicular temperature frequently due to a varicocele or exposure to excessive heat often have tapered sperm quality and may be missing the acrosome, the packet of enzymes at the tip of the sperm head that allow the sperm to bore through the coating of the egg.
From: An in-depth look at fertility

I also found this article: Deterioration Of Sperm Morphology In Men Exposed To High Temperature

Forward progression has to do with how well the sperm are at swimming forward (aka motility). I don't know much about it but Vitamin E and Selenium are supposed to help with motility

Hypoosmolarity has to do with too much water being in the sperm cell I believe, remember osmosis from biology class in high school? I couldn't find anything that directly spoke to directly this but this quote points out some possible things to research more on:
In mammalian cells, hydration may change dynamically in response to hormones, ethanol, aniso-osmotic environments, oxidative stress or by cumulative substrate uptake.
from: Hepatocellular hydration: signal transduction and functional implications.

A Shot at Improving Your Semen Analysis

(to a woman who's husband was just diagnosed with 2% morphology)

I wouldn't give up hope just yet, since your husband has been away there is a good chance that things got a bit sluggish and studies have shown that ejaculatory frequency can improve sperm quality. You guys should get busy and that's one step in the right direction.

There are a bunch of people on the boards who have gotten pg with 2% morphology. We did it too, though we had a blighted ovum.

I would suggest that since it takes 120 days to grow new sperm, that you repeat the test but after a few months of supplementation, healthy eating, destressing and regular intercourse. Then you could also do as Sonnet mentioned, using a condom to collect the sample -- how you collect the sample can influence what comes out and a longer pre-ejaculatory arousal period is associated with a greater quantity of sperm in the sample (I can't find the reference but its out there).

The UR had us do the SPA (Sperm Penetration Assay) 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. This might show how your guys swimmers are performing IRL.

Laboratory Section - Sperm Penetration Assay
Sperm Penetration Assay

Also, having more sex prior to ovulation when you have fertile quality mucus means that you are pooling the available sperm which can make up some for the paucity in a single sample (see POOLED SPERM COUNTS)

Dr Perloe (guest host for chats here on the boards sometimes) suggested to us that the sperm DNA fragmentation test (SCSA) would be worthwhile but we got a BFP and didn't need to -- maybe soon we will do it if we don't get a BFP (having my fibroid out might have improved our fertility).

Supplements can help, we've seen some good results on the MFI board from various regimes that are all fairly similar. I expect that your DH hasn't been eating a lot of fresh veggies while he's been away, so he probably could do with a little extra for now.
I wrote up what supplements and doses my partner has been taking for another board member recently so I'm posting that here, other ppl might have additional recommendations:

Grapeseed -- 120 mg, 1 each day
L-Carnitine -- 250 mg, 1 each day sometimes
Arginine -- 500mg, 1 each day sometimes
Multi-vitamin -- 1 each day
Zinc -- (with c) -- 23mg, 1 each day sometimes
Rhodiola Rosea -- 300 mg, 1 each day

The ones marked sometimes he doesn't take every day, but instead several days a week. He senses that his body doesn't need it, which if your DH is in tune with his body he might find with some of the supplements as well. For starts though, I would do take all of these (rhodiola is optional though it might help as well, it is a potent anti-oxident and adaptogen which can help DH feel better after the stress he's been under -- they gave it to Russian fighter pilots in the Soviet Union to deal with the G-force better) -- he should do the supplement routine for three months and you should be able to see a difference in a subsequent analysis.

More information to check out:

Sperm

Male Infertility

Male Fertility or Infertility

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 tried to abstain for 3-4 days before a S/A but also made sure that we were helping keep production up all month long. In other words you will have better results if your partner is having frequent ejaculations the whole month through (1-2 per week we tried to average, more if we were in the mood).

In May we did an SPA test (sperm penetration assay) which they do a basic S/A with as well. We BD on the 14th, abstained for 4 days and did the test on the 18th and then BD again for the next 4 days and I ovulated on the 5th day. We got pg this same cycle.

Sperm Penetration Assay links

http://www.regence.com/trgmedpol/lab/lab11.html

http://www.infertility-male.com/labtest/spabackground.htm

This may sound crazy but caffeine can help sperm swim faster. Truly. Read about it:

Coffee makes sperm speed up
18:24 14 October 03
NewScientist.com news service
http://www.newscientist.com/news/news.jsp?id=ns99994267

You might have your partner stop and get a double espresso before the next IUI or you get up early and make/get coffee for him and switch your BD schedule to the AM (as the coffee certainly would disrupt sleep if taken at night).

Just for everyone's information I thought I would share with you a reason why I thought we could influence our fertility in spite of doctors telling us that morphology is just something that you are born with and you can't change. We were working with a biotech company a couple years ago and they had developed a compound that would enhance a plants ability to both combat pests and disease and at the same time had the added benefit of increased fruit production of increased proportions. That was why I went looking for all those links in my sig for sperm maturation and morphology. I thought surely there has got to be a way to influence this process. Finally I got my partner to agree to try the extended supplement regime, thinking that at the very least we would be improving the opportunity to grow better sperm. Take a look at the PDF article at the link below when you have a chance and you can see what I'm talking about.

Messenger for Citrus
http://www.edenbio.com/documents/Eden+Citrus.pdf

Today I've been feeling mostly good but then burpy- yucky, then STARVING (at 11am after I already at leftover Thai food for breakfast and a banana and a glass of almond milk at work), so I had to go buy something pronto. I don't know what would have happened if I didn't but it sure felt desperate.

My partner and a good friend at work are both noticing the physical changes in my already (I noticed them two weeks ago). I've got a little extra fat around my belly button, I'm starting to be a little more rounded in the front as well, and still with the big boobs. I'm thinking about getting some new bras because the ones I have aren't really enough support but that was just based on what I own on not because I look like Busty Dusty (ever hear of her, famous porn star).

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

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!

All About Sperm

These are some of the better links I've found about sperm generation and basic men's infertility.

MALE INFERTILITY

Male Infertility Overview ~ Assessment, Diagnosis, and Treatment

Male Reproductive Problems

Advanced Urology - FAQ's on Information pertaining to Male Infertility

Infertility in Men


SPERMATOGENESIS

Maturation of a sperm cell - diagram

Spermatogenesis Slides -- with details of various constituents involved in process

Spermatogenesis

MORPHOLOGY

Semen Characteristics: Advancement in Andrological Assessment - PDF
Indian Journal of Clinical Biochemistry, 2005, 20 (1)
173-183
R.S. Sharma** K.K.Gaur#, P.C.Pal*, Monika Manocha*, Deepak Tomar*, Arif Azam Khan*, Vinita Tripathi*, Vineeta
chattree* and A. Kriplani+

The Importance of Sperm Morphology in the Evaluation of Male Infertility

Poor Sperm Morphology

Sperm Abnormalities: Testicular Causes

Illustration showing nomal to abnomal sperm

More images showing sperm morphology (Google Image Search)

Differential production of reactive oxygen species by subsets of human spermatozoa at different stages of maturation

FOR MORE INFORMATION VISIT:

Vasectomy Reversal Information

Semen Analysis

Improving Your Semen Analysis