I’m an IVF doctor. Couples aren’t having enough sex to get pregnant

Our series The Expert View brings you specialist health advice from professionals. Here, Dr Yusuf Beebeejaun, medical director of Create Fertility St Paul’s, honorary consultant at King’s College Hospital and president of the Royal Society of Medicine’s Women’s Health Section, explores the sometimes surprising reasons behind infertility.

One of the first things I ask everyone who comes to my clinic is how often they’re having sex, and when. Nobody is shocked by the question; they know why they’re there. But the answer often tells me that they don’t need in vitro fertilisation (IVF) at all.

If a young couple hasn’t been trying for long, often what they need is more time, less pressure, and more regular sex. Some couples are surprised when I send them home and say, “Come back to me if you’ve not got pregnant after a year.” IVF shouldn’t be offered just because it’s available: it can be financially taxing, time-consuming and psychologically draining, so it is only a good option if a couple really needs it.

What we know and see in clinic is that frequent sex gives you the best chance of conceiving naturally. A new Norwegian study of more than 64,000 women, published last month, found that women who had sex more than four times a week in the month before they conceived got pregnant faster: in 3.7 months on average, compared with 4.8 months for those having sex less than once a week.

Sex doesn’t have to be four times a week; the current Nice advice is to have sex every two to three days. And yet some couples I see are making it harder than it needs to be.

People are having less sex than previous generations

Large British surveys show we’re having less sex than previous generations. The National Survey of Sexual Attitudes and Lifestyles found that less than half of 16 to 44-year-olds now have sex once a week. The biggest falls are among over-25s and couples who are married or living together.

It’s hard to say exactly what’s driving it, but I see the pressures in my clinic. Couples are working longer hours; they’re tired, and they have other responsibilities like caring for elderly parents, all of which eat into their time together. And work doesn’t stay at work. It’s on your phone, so there’s always an email, a notification or a group message intruding on your personal time.

I also see couples living in different cities, in New York and London or Singapore, for example, making it harder to achieve a pregnancy.

Trying to conceive brings its own pressure too. Sex starts to feel like another task, and very clinical, so people want it less. Some then turn to fertility treatment to make things happen faster, not because they need it.

Too much data, not enough intimacy

One issue is that some couples I see are over-tracking the ovulation window. Knowing roughly when you ovulate does matter. An egg survives for only about a day after it’s released, but sperm can survive for several days. So the aim is to have sex in the days leading up to ovulation, so sperm are already waiting when the egg arrives. But many of the couples I see have taken this to extremes.

They’ve got an Oura ring, a period app, something measuring their heart rate and ovulation sticks, and then they want a scan as well. Monitoring all this is a lot of work, and different devices have different sensitivities, so they get conflicting results and false alarms. That just adds to the stress.

Apps are useful, but they’re based on algorithms that typically assume a 28-day cycle. If your cycles are longer or irregular, your fertile window shifts from month to month and the app can miss it. Temperature tracking can be thrown off by something as simple as a heatwave. Ovulation kits, which measure the hormone surge before you ovulate, are more reliable.

So my advice is to pick one method that works for you, perhaps an app backed up by an ovulation kit, and don’t get too intense about it. Tracking everything turns sex into a medical chore and leads to information overload. People get tired of it, and that’s often when they turn to IVF.

Pressure leads to performance anxiety

Impatience doesn’t help either. I see plenty of the worried well: young couples who’ve been trying for a few months and assume something is wrong. But one month of trying is just one attempt, because you only ovulate 10 to 12 times a year. According to Nice, more than 80 per cent of couples conceive within a year if the woman is under 40.

The anxiety about not getting pregnant finds its way into the bedroom. Often the woman has been doing all the tracking, and then the window arrives, and the man feels he’s now got to perform. That pressure can cause performance anxiety, which can lead to erection problems, which makes the anxiety worse. It’s a vicious cycle.

Of course, when a couple comes to my clinic, we first rule out any medical causes. We’ll check the egg reserve, the tubes and the sperm. Poor sleep has an impact, as do some medications and low testosterone. We do see men taking anabolic steroids or testosterone they’ve bought online, and that can impact sperm production. Sometimes women come to the clinic alone, but issues like these explain why I need to see the man as well.

Once we know there is no medical reason affecting conception, my advice is usually simple: stop stressing, give yourself more time and have regular sex.

Don’t save up sex, but don’t overdo it either

Some men seem to think they should abstain for 10 days or a fortnight to “save up sperm” for the fertile window. It doesn’t work that way.

Sperm is made in the testicles, which sit outside the body because sperm production needs a temperature a few degrees cooler than the rest of you. Once mature, the sperm is stored until ejaculation. The longer it sits there, the more it’s exposed to oxidative stress, which can damage the DNA inside the sperm. We call this DNA fragmentation, and it’s something fertility specialists are paying increasing attention to. Research shows that shorter gaps between ejaculations are linked to lower levels of it. So regular sex throughout the month, not just in the fertile window, helps keep sperm healthy.

But that doesn’t mean more is always better. I do see couples who go to extremes and decide their chances will be improved by having sex several times a day. It isn’t necessary, and it piles on the pressure. It also reduces the volume and concentration of sperm, and the benefits plateau. And frankly, who has the energy?

If you’re older, seek fertility help sooner

Finally, there is one thing couples shouldn’t be relaxed about: their age. It’s the single biggest factor in fertility, especially for women, but for men too. If the woman is under 35, see your GP if you haven’t conceived after a year of regular sex. If you’re over 40, go after six months.

In my research, we look at “time to live birth”, meaning how long it takes to have a baby, and the older you are, the more that time matters.

This job can skew your view. One in eight couples struggle to conceive, but they’re the only ones I see. I never see the seven in eight who get pregnant on their own. As for me, I’m 39, but I don’t have children yet, though I’d like to. When the time comes, I hope I’ll take my own advice: relax and keep having sex.

As told to Laurel Ives

Try full access to The Telegraph free today. Unlock their award-winning website and essential news app, plus useful tools and expert guides for your money, health and holidays.