Infertility/Fertility/factors for below average motility and rate of progression
My husband and I are trying to conceive and I have a question about the quality of his sperm. He's had a couple of analysis and his count was average, but motility / rate of progression was below average. I recently read an article that said everyday ejaculation was important in terms of avoiding sperm DNA damage.
This is contrary to what I've read that around the time of ovulation you should only have sex one every 36-48 hours. The article I referenced is a few years old, so I was wondering what the current opinion among infertility doctors is about this. In general, we only have sex twice a week, and I'm wondering if this is contributing to the below average rate of progression.
Hello Peggy from the U.S.,
Thank you for sharing that article with me. I try to keep current on all issues within my specialty but did not see that one. It is quite interesting since when I do ovulation with timed intercourse treatment cycles, I have my patients have intercourse every day from the point of HCG trigger. I also counsel patients trying naturally to have intercourse every day beginning on cycle day #12-16 (the range of ovulation). I've had this opinion since the beginning of my career based on studies that show that sperm should be present within the tube a the time of ovulation. Another study from several years ago, showed that if the sperm was not present PRIOR to ovulation, pregnancy did not ensue.
It is difficult to know if DNA fragmentation rates are part of the explanation, but it is certainly a worthy thought. The problem with DNA fragmentation rates is that it is dependent on the specimen that was received, but each and every specimen is a new specimen. That is why I don't do nor recommend that test. But the Author's conclusion is worthy to note and consider.
In terms of the idea of sex every other day, that is a lay opinion (wives tale), and one held often by general ObGyn's and other doctors that I frequently hear and encounter. I disagree with that opinion, as I've explained above because if the day of rest is the ovulation day, then ovulation is missed. However, I can't say if daily intercourse is the opinion held by all infertility specialists because don't think anyone has taken a poll to find out.
My recommendation is if you have regular periods, and keeping in mind that the luteal phase (the days following ovulation) is 14 days, take several cycles and average the number of days in the cycle. Then subtract 14 from that number and that gives the approximate day of ovulation. Then, have intercourse daily beginning two days before this date until two days after the date. This is the fertile period. This allows for a day or two deviation in ovulation. I do recommend that you stop intercourse for 3 days prior to the day that you are going to begin the intercourse days. This is because the volume and count do decrease each day. You want to have the maximum count and motility at the time of ovulation.
I'll just comment on your description of your husband's analyses, if I may. Keep in mind that the semen analysis is an INDIRECT measure of what you really want to know, which is whether the sperm can fertilize and egg. It only takes ONE sperm. Because we can't do that direct test, scientists did what they could do which is to look at a specimen in every which way that it could and describe all the parameters. Therefore, my interpretation of semen analysis is not strictly based on the number but what it may herald. Remember that motility is actually a measure of the number of live sperm because even sperm that is not progressing forward, but moving is counted in the motile count. That number therefore, adjusts the number of sperm that have the potential to make it to the egg. More importantly, the semen analysis may reflect a dysfunction of the sperm i.e. the ability of the sperm to fertilize an egg. We now know that this is the case because with IVF, we can see that impaired sperm placed with the egg in a petri dish, do have an impairment in fertilization i.e. a high fertilization failure rate. So, the real interpretation of an abnormal semen analysis should be that the sperm may be impaired and for that reason, the current recommendation for treatment is to consider ICSI (sperm injection) in conjunction with IVF.
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com
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