When it comes to a discussion of human fertility, the saying ?life is not fair? seems to have extraordinary significance. Couples who don't want to get pregnant seem to be the ones that do and the ones that do?don't. Nobody knows this better than the couples that desperately want children but fail to conceive, month-after-month. As the biological clock keeps on ticking, is there anything more that these couples can do? Absolutely!

Having interviewed hundreds of couples who have meticulously documented the woman's fertile days and the days on which intercourse occurred, it has become crystal clear that: (a) most couples think that they are doing a good job of having intercourse on all the right days, while (b) the vast majority are completely missing the boat!

What is so difficult about Fertility Focused Intercourse?

Let's start with the basics of female fertility cycles. First, Women of normal fertility are not fertile very often. From a biologic perspective, the most fertile woman on the planet can only conceive between 5 and 6 days per menstrual cycle. A woman with reduced fertility might have significantly fewer days that are truly fertile, perhaps 2 or 3. According to simple mathematics, if there are only 3 days per month to conceive, that is only 36 days at the end of the year. Second, not all fertile days are created equal. Intercourse that occurs on ?the day? of ovulation can be assumed to be the most fertile day of the menstrual cycle, but even then the probability of achieving a pregnancy is never 100%!

When does ovulation occur?

Frequently, ovulation occurs approximately 14 after the first day of the menstrual period. In a classic study by Vollman[1] of 14,848 menstrual cycles, ovulation as detected by a shift in basal body temperature occurred on exactly day 14 in only 1,591 cycles (10.7%). Thus the exception here is far more common then the rule. The 28-day normal menstrual cycle is simply a myth. The first step in fertility focused intercourse, therefore, is to do away with any notion of a calendar and to adopt a method of detecting when ovulation actually occurs.

There are many ways to ?detect? the day of ovulation such as monitoring LH and estrogen in the urine or checking for cervical mucus and changes in the basal body temperature (just to name a few). Unfortunately, however, there is no way to ?observe? when ovulation actually occurs. No matter what method you are using, the margin of error is at least plus or minus 2 to 3 days (sometimes more). This means that if you rely on your favorite indicator of the day of ovulation to tell you when to have intercourse you may be missing the most important day to conceive on a regular basis.

What is the best way to time intercourse?

So what is the best advice? Unfortunately, healthcare providers frequently offer some of the worst information. For example, ?we were told to have intercourse ?every other day? in order to ?save sperm.?? ?Have intercourse every month starting on day 6 for 12 consecutive days.? Or even worse, ?because you do not know when the most fertile day is you would have to have intercourse every day to maximize your chances.? ? nonsense!

From this brief discussion, the best advice is: (a) choose a method of fertility monitoring that will give you a few days notice that ovulation is going to occur. This means monitoring estrogen levels directly or the effect of estrogen on saliva or cervical mucus. (b) When fertility begins, intercourse should occur daily until at least 2 days after ovulation is detected. Once released, the egg can only be fertilized during a narrow window of approximately 24-hours. You want to make sure that intercourse occurs on ?the day? of ovulation in order to maximize your chances.

Intercourse Patterns

By now you have figured correctly that fertility focused intercourse is truly a ?labor of love.? It is not easy! It might mean having intercourse as many as nine days in a row. Even among couples with the strongest convictions for attempting to achieve pregnancy a few fertile days always seem to be missed. Here are some helpful suggestions:

1. Plan in advance. If you were going to go on a fancy date with your spouse you would give a few days notice. If you know the fertile days are coming, then you likewise will have time to prepare for them.

2. Get your priorities straight. If the doctor scheduled a procedure to test some aspect of your fertility you might take a day off work. Furthermore, you would probably follow through even if you had a headache! Should you not subject yourself to similar inconveniences when your most fertile days arrive!?

3. Get professional help. Believe it or not, there are professionals who can help you make sense of all this and give you real good advice. The American Academy of Fertility Care Professionals is an excellent place to start.

If you and your spouse have been having difficulty achieving a pregnancy, then just remember?knowledge is power. In this case, the right knowledge may even give you the power to procreate! You may as well consider the question of when to have sex to be the single most important issue. Why? Because there is no diagnostic medical procedure, test, or surgery that is going to make you pregnant. If you just had surgery to correct a fertility problem, for example, and you are not following these instructions you could very well be making out badly on your investment. Fertility focused intercourse may not be easy, but it is not mission impossible'it is mission responsible?and the responsibility falls upon both you and your spouse.

Have fun!

1. Vollman, R.F., The Menstrual Cycle. 1977, Philadelphia: W. B. Saunders.