the itty-gritty

A good friend of mine loves to tell the story of her high school sex-Ed teacher, who had a visceral–at least a visible horror of anything to do with sex.

The teacher had no problem with the biology itself, no problem with the his-and-her-parts diagrams. She rocked when it came to embryos and she glowed with righteous certainty when discussing “Responsibility”.
But to even tiptoe towards a pronounced penis was to see her collapse into herself like an imploding star. Questions of the clitoris, its use and/or existence were enough to send her voice choking and dwindling to an agonized strangle.

And she called sex the “Itty-Gritty”.

So, in honor of Sister Mary Josephine: Onward to the Itty-Gritty!

Now, I think we’re all clear that having sex can lead to pregnancy. But if you are trying to optimize your chance of pregnancy, are there things to do during and after sex that can help?

A few true / false questions to get us through:

You will increase your chance of pregnancy if you happy baby pose after sex (lie on your back and put your legs in the air).

Answer: false.
It may seem like common sense that you increase your pregnancy chance the longer the semen  (and the important player in the semen, the sperm) stay inside the vagina. Less leak, more pregnancy. This isn’t altogether true, and I’ll tell you why.

Those sperms move fast and there’s a lot of them …
With each ejaculation, about 200-300 million sperm are sent into the world to fend for themselves. Of these, a few hundred actually reach the cervix. From there they move upward and onward to the woman’s uterus and fallopian tubes. This is where they usually meet up with the egg for fertilization.

Most of the active sperm will reach the cervix within 90 seconds, and will be inside the woman’s uterus and / or fallopian tube within 2 minutes of ejaculation!  The leftover sperm (the ones left inside the woman’s vagina) all die within 2 hours. The “successful sperm” will stay alive and well in the woman’s reproductive tract at least 24 hours (and up to 72 hours) after sex. This is why, if you remember from my previous post, your special sex days are before you ovulate – because the sperm hang out in the reproductive tract for days waiting for that egg. Living sperm have been found in the woman’s fallopian tube as long as 80 hours after sex.

I know there’s a joke in there somewhere…

Okay, True or False:

Having an orgasm helps get you pregnant. (This one’s only for the ladies).

Answer: false.

Female orgasm might help the sperm move better, but this has never been correlated to increase in pregnancy rates.

Using different types of lubrication can help or hinder your chance of getting pregnant.

Answer: true.
Go to any sex store, or even look on your RiteAid shelf, and you’ll see a myriad of different lubrications. The difference is mainly the base: water based, silicone based, oil based, and fertility lubricants. Obvious by then name, the best choice is the fertility lubricants. Water based lubricants, like KY Jelly and Astroglide, and we think silicone based too, can actually decrease the movement and amount of sperms available for use after ejaculation.

Oil based lubricants like mineral and canola oil are okay to use. These lubricants got a bad rep because they can break latex condoms. But you’re not using condoms anymore, so go ahead!

There are some lubricants specially formulated for women trying to get pregnant. PreSeed, for example, was developed specifically because it was found that likes of KY and Astroglide were bad for sperm.

So bottom line: avoid the water and silicone based lubricants. Use mineral oil or PreSeed.

More little known sperm secrets and lots more Itty-Gritty in upcoming posts!

Ovulation & You

These fertility goddesses are from different religions, different times. But to me, beyond being lovely ladies, they also share a message that may sometimes seem lost amidst the tension and concern that many bring to the question of their own fertility (even before they have any reason at all to worry): bearing children is a beautiful, natural process that should empower women.

   Fertility figure, Huaztec                      Venus of Willendorf                Goddess of fertility, Huastecan

Now, in terms of when and how often to have sex to enhance your likelihood of conception, I’m pretty sure the goddesses would just smile knowingly and tell you to get busy, but there actually is an answer that some (mortals) find very helpful. So…


Or, more specifically:


Here’s the good news: you have Special Sex Days!

You have 3 “special sex days” each month – the days you have the highest chance of getting pregnant from having sex. These days are the day you ovulate, and the two days before that. So if you are going to ovulate on May 20th, your special sex days are May 18th, May 19th, and May 20th. Your “fertile window” each month usually includes the 3 days before your special sex days too (so in the example above, May 15th to May 20th).

So, the logical question: how do I know when I’m going to ovulate?

Most of the time, unfortunately, predicting ovulation is hard. Sorry.
Here are some of the ways, easiest one first:

Timing: Even with clockwork periods, monitoring your symptoms (like mood changes), you have only about a 50% chance of accurately predicting your day of ovulation. To get this 50% chance, calculate 14 days before your next period will start. There is a 50% chance you are ovulating on that day. Not great, but worth doing.

Cervical mucus: Yay! I’d say that cervical mucus is, in itself, a pretty solid entry into the category of “Things Your Significant Other Doesn’t Want to Hear About.” Basically this is your vaginal discharge. It changes throughout the month. Describe it: dry, slightly moist, damp and sticky, slippery and clear? The most likely indicator of ovulation is when your discharge is slippery and clear. There will also be more of it. Done.

LH (luteinizing hormone) kits: Let me put it out there: I have mixed feelings about these.
First, can they tell you when you are ovulating? Yes. LH increases right before ovulation. When your LH kit shows your LH surge, you will ovulate within 24 hours. So, when your kit is positive, it’s one of your special sex days. That’s the good part.

The bad part: They aren’t always accurate. About 7% of the time the test will be positive when you actually didn’t ovulate at all, and up to a whooping 35% of the time it can say no ovulation when you actually did.

Some studies have shown that using these kits can decrease a couple’s time to pregnancy. They obviously take out the spontaneity of sex. I know people who use them and complain that it makes sex feel like a job – sometimes, even with a job you love, you don’t feel like going to work. If your LH is positive, you feel guilty taking a sick day.

The kits look like urine pregnancy tests, but they measure luteninizing hormone instead of pregnancy hormone. You can buy these kits in drugstores like RiteAid or CVS. They usually cost about $2 per stick, and I don’t have a specific brand I recommend. You need to read and follow the instructions of your kit because the tests are calibrated differently, and your urine LH level changes throughout the day too. You should check about 3 to 6 days each month, starting the 3 days before you think you will ovulate.

My bottom line: if you are anxious about getting pregnant, or need to time your intercourse for other reasons (travel, family issues, etc), go ahead and get them. I’m not opposed to using them.  I do think though, with LH kits and temperature monitoring below, some of the fun and sexiness of getting pregnant is compromised. If you feel differently, please share with me!

Basal body temperature monitoring: This won’t be as helpful to predict your special days to have sex, but it can be used to get to know your cycle. Skip to the last paragraphs right this second if you don’t feel like getting way too technical about a timing mechanism that you should really only avail yourself of if things haven’t moved along as quickly as you had hoped …

The details: your temperature increases slightly, about 0.5 degrees, between 24-48 hours after your LH surge. It stays elevated for about 10 days. So, basically, you have your LH surge and ovulate. Your basal body temperature takes up to 48 hours to show that you ovulated. Because your special sex days are the 2 days before ovulation, and the day of ovulation, using something that shows you that you ovulated 1-2 days ago is not helpful for the timing of intercourse. But, like I said, you can write down when you ovulated each month, and you may notice a pattern over time, which will help you find your special sex days in the upcoming months.

You need a special basal body temperature thermometer. These thermometers show very small increments of temperature differences, usually 0.1 degrees. That makes it easier to know when your body temperature is 0.5 degrees different. Experts recommend using a mercury thermometer (the digital technology used for thermometers is surprisingly less reliable than mercury thermometers, at least as of now).
Your basal state is right in the morning when you awake, after sleeping, and fasting. Take your temperature before you move, before you take even a little sip of water.

Now, if you’re joining us post-Basal, welcome back!

Timing sex for maximum fertility is a lot more complicated then the ‘How often to have sex’ question. After reading all that, you may feel a little intimidated, but don’t be … not that me saying ‘don’t be’ is really going to help.

What might actually help is this: first, when you set out to conceive, just enjoy the excitement of being off birth control for a couple of months. Don’t plan, or study, or read about it so much that business … overrides pleasure, so to speak. The worry and pressure that can result doesn’t help anyone. If you don’t get pregnant in a few months, consider maximizing fertility with some of the techniques above.

And if you happen to put a particularly beautiful flower at the base of your garden fertility goddess, it won’t hurt a thing!

When are you a fertility goddess

When I first became an obstetrician-gynecologist, my uncle gave me this statue head. “A fertility goddess” he said, “so you get more patients pregnant.” A sound business goddess!

Does she promote fertility? Well, the surrounding succulents are doing wonderfully, so she’s definitely on the right track.

Goddess in the garden, or not, your chances of getting pregnant each month can definitely be affected by how often you have sex and when you have sex. Topic for today:


The numbers are pretty simple.

In couples that have sex every day, the chance of getting pregnant in a single cycle (the woman’s menstrual cycle) is 37%. If you have sex every other day, 33%. If you have sex once weekly, 15%. These percentages have nothing to do with when you have sex, just how often you do the deed.

Also, semen quality is optimal when ejaculation happens more frequently than every 5 days. So yes, if you don’t have intercourse, your man needs to find another release at least that often to up the chances. He probably won’t mind those particular marching orders.

Tomorrow’s topic: When to have sex? Goddess says, “Now! Now!”