IVF and Sex

One of the major issues that couples face when going through fertility treatments to start a family is what the process will mean for their sex life. We know that most of you out there have your eye on the prize, so to speak, and the main objective in this journey is a baby. Balancing your needs, the needs of your partner, and the large amount of (often conflicting) information on the subject can be overwhelming. We want to talk a little bit about the implications of fertility treatments, and specifically IVF, in the bedroom, both clinically and emotionally.

 

Let’s Talk About Sex

If you are reading this, you have probably been doing a lot of talking about sex, or at least thinking about it. We learn as young people that this is how babies are made. When did it get so difficult?! We want you to know that it is a very common thing for couples to not be able to conceive a child naturally through intercourse. In fact, infertility affects nearly 12% of the reproductive-age population in the US—that’s around 7 million people! You are not alone! Infertility is defined as the inability to conceive after 1 year of unprotected sex (6 months if over 35).

 

Throughout the process of fertility treatments—from diagnosis to assisted reproductive technologies like IVF—you and your partner will be poked, prodded, and tested more than you can imagine. A woman going through IVF will be injected full of stimulating hormones, and chemically placed into menopause, all before the eggs are retrieved. For most couples, sex is the last thing on their minds during this stressful period. But many ask, “Can we have sex?” The answer to this question will differ from doctor to doctor, and clinic to clinic. The most common instruction is to abstain from sex between the embryo transfer/implantation and the first beta. This is the first blood test taken two weeks after transfer to check for early signs of pregnancy. One main reason to not have sex in this period is that uterine contractions during orgasm could interfere with implantation in the early stages. For this reason, some doctors say sex without orgasm is OK, and some recommend condom use and “gentle” intercourse if the couple is eager to resume intercourse. This is a very critical step in the IVF process, where you want to maintain the most conducive environment possible for implantation and early pregnancy. To many, this is just too critical a time to introduce any other factors. Some women are advised by their doctors to abstain for only 24-48 hours after transfer, and you will find women who have been told everything in between. You should get as much information as you can on this topic, but ultimately you will make the decision based on what feels right for you and your partner.

Sex Before Transfer

As we have learned, the IVF process begins with hormone injections to stimulate the follicles to produce multiple, viable eggs. This period is commonly called “stimming.” Many women experience tenderness and pain as the ovaries will become physically larger while they are working overtime producing eggs. There is a risk of ovarian torsion during this period. Ovarian torsion occurs when an ovary is twisted in such a way that the ovarian vein is distressed, resulting in severe abdominal pain and only resolved through surgery. Enlarged ovaries are at particularly high risk for this. It is for this reason that all torso-twisting activities and other abdominal exercises are not advised during stimming.

In the days after egg retrieval, it is advised to abstain from intercourse due to the risk of infection. The wall of the cervix and uterus will be sensitive from the retrieval procedure. Most women experience discomfort from the enlarged ovaries and the Procedure itself. You will see anything from 24 hours to the entire period between egg retrieval and embryo transfer to wait to have sex. This is up to you and your comfort level, and the advisement of your doctor.

Just to make things confusing, many doctors actually advise that you have sex the night before the embryo transfer, with many specifying sex with an orgasm. The seminal fluid has some hormones that some say can soften the cervix and make transfer easier. Orgasm increases blood flow and could help with implantation. On a personal level, you may opt to have sex at this point if you plan on abstaining during the period between transfer and first beta, as is the most common recommendation. Once again, this is up to you. The bottom line is that sex at this point is unlikely to have negative effects, providing you are feeling up to it, and it may actually have a positive effect on the process.

Sex after Transfer

And then comes the big day….embryo transfer. This is for what you have been waiting and prepping your body for weeks, probably longer. The period after the transfer is a very sensitive time for your body. The healthy young embryo(s) have been implanted into your uterus and it is now up to your body to create a welcoming and healthy environment in which they will thrive.

Once again, you will find different guidelines on sex during this period from different doctors. The overwhelming majority say no sex between transfer and first beta, the blood test to detect signs of early pregnancy given 2 weeks after transfer. In addition to sex, it is recommended that you abstain from baths and hot tubs, all exercise, lifting anything over 5 lbs, alcohol, and various other things. This issue of extended bed rest is a heavily contested one, with most practitioners believing it to be too extreme and actually detrimental to the process as it limits blood flow to the uterus. What most all do agree on, however, is at least a 24 hour period of limited bed rest, no showers, nothing strenuous.

After the dreaded two week wait, you will have your first beta HCG test, which will test your blood for the hormone beta human chorionic gonadotropin. It is the most accurate and reliable pregnancy test you can take. Depending on the results, you may have more beta tests until the doctors determine that you are pregnant and safely out of the danger of an ectopic or chemical pregnancy. You may be advised to abstain from sex until the first beta, or throughout all of them, or until the first ultrasound or confirmation of heartbeat. Some women opt to wait until they are through the first trimester. After you are released by your doctor for sexual activity, it is up to you and your partner how long you will wait.

Bottom Line …

For each doctor or clinic you talk to, you will likely hear a different set of recommendations on sex during IVF. We have heard just about all of them! Our goal here is not to tell you what is right or wrong, but to offer as much information as we can to help you make that decision yourself. It ultimately comes down to what you and your partner are comfortable with.

And for the Men?

We have talked a lot about what is going on inside the woman’s body during IVF and how it is affected by sex. What about the man? What are the instructions he will hear as you go through the IVF process? If you and your partner are using a fresh semen sample, he will produce this through ejaculation on the same day as the egg retrieval. He needs to not have ejaculated for 3-5 days before giving his sample. It is a small window between waiting too long and not waiting long enough. He needs to have clean pipes but a few days buildup so the most optimal sample is produced! After that his work (as far as this goes!) is done.

Have sex

From the Clinic to the Bedroom

As we all know, there is a lot more to the question of sex during IVF than a doctor’s recommendation. The journey you will go through is long and can be stressful. You are hyper-focused on one thing: having a baby. It is important to keep your needs and the needs of your partner in mind. it is easy for your relationship to be pushed aside as you put all your time and energies into IVF.