26 November 2016

Make Love, Not Babies; reframing "trying" to conceive

I should start with a disclaimer:
The opinions and experiences expressed in this post are purely that of the author.
This is not meant in any way to be directed at any particular person or be in response to any particular comment.
I fully acknowledge that my own personal experience is nothing more than an anecdote, and a data set of one (1) generally proves nothing.

My wife was (is!) really excited about starting a family. I've been looking forward to it too.
I convinced her to agree to wait just a couple more months after we got married to save up some money so we can both take 6 months to a year off to be full time parents.

And I also asked for one critical thing:

Can we please not "try" to have a baby?

Can we instead just make conditions such that it is possible, and then "allow" it to happen?
She agreed to this.
No testing kits, no books, no thermometers, no fancy expensive lubes, and no pills of any kind.

Of course she took vitamins with folic acid and DHA, and she has a free app where if you put in the dates of each period it will predict the next one as well as likely fertile days based on the historical pattern. But she was doing both of those things for the past year anyway.
The app has the option to add temperatures to improve accuracy of fertility prediction, but we just took the calendar based prediction as a good enough rough guide. Fertile days start several days - up to 5 days - before ovulation anyway, and only last about a day after, so knowing the exact day is of limited usefulness anyway - once you know for sure its basically too late.

Here's what we did:
We had sex often.
At least once every day (with possible exceptions during her period), usually twice (or more) on suspected fertile days.

The conventional wisdom, and what "everyone" recommends, is to avoid having sex every day, however it isn't backed up by science.  If you read the studies (not just "expert opinions"), people who mate every day tend to be more successful than those who only do it every other day.People who mate every other day are more successful than those who try to "time" it.




As far as "depleting" sperm outside of the fertile window, that simply doesn't matter one way or the other, it just doesn't work that way - there is no reserve. Each time all sperm available are used, and the count is reset to zero. So it wouldn't make any difference if he had sex twice a day, every other day, or just once the day before, the first time during the fertility window will only consist of what built up since that most recent time, in this example 24 hours ago.

Meanwhile, ovulation testing will tell you when, or more likely the next day after, ovulation occurs. But the fertility window is the 5 days leading UP TO ovulation. If you wait until testing says it is the right time, its actually just about too late. You want (healthy) sperm already waiting in the fallopian tube by the time the egg gets there.

The egg has no way to distinguish the number of sperm in it's general vicinity that come from any particular ejaculation. Sperm live as much as 5-6 days (hence the 5 day window). So even if the sperm count per sex instance were half as much, the total sperm available for conception is the exact same amount. In other words, 2 consecutive days with 30 million sperm counts leads to the same total sperm in her reproductive tract as 60 million once. Except that his body will more likely ramp up production to the maximum it can with more frequent sex (though it would take 1-2 months to make a difference, since that's how long sperm production takes), so it is likely slightly more total, (for example maybe instead of halving with doubled frequency, the sperm count drops to 31 million per time as it tries to keep up, resulting in a slightly higher total of 62 million).
Ultimately, the "minimum" sperm count thing is just a probability/statistic thing, not an actual reproductive biology rule. Ultimately, it only takes a few dozen sperm. 
There is evidence that production rate in several species of animal (the ones that have been tested) matters more than absolute count, and it's documented that production rates vary in humans based on a number of factors including environment, diet, drugs, possibly age (conflicting reports) and notably testosterone - which in turn is known to increase with more sexual frequency. 
Unfortunately, the study that would give a more direct answer to the question of why is daily sex more effective than every 2nd day has never been done, but the bottom line is that couples who have actually had sex every day tend to get pregnant faster than ones who do every other day. What ever the reason(s) turn out to be, whenever real world results conflict with "expert opinion", reality wins.

But of course all suggestions of frequent sex are always reported with the caveat that if you feel like its a chore, it can backfire.

And that last bit is what brings us back to that very important thing we agreed to:
not "trying" to get pregnant.

It's sort of how work is better when you don't need the money.
Or if you reward a child for playing their favorite game, they stop playing it spontaneously.
Why volunteering feels so much more rewarding than employment.
Or why monetizing a hobby makes it less fun.

Anytime you do something for some other external reward, it takes away from any intrinsic value that activity might have. Its just human nature.
So we didn't have sex "to get pregnant".
We stopped using birth control, and we had sex because sex is fun, and it feels good, and we are attracted to each other, and it makes us feel closer to each other and strengthens our relationship.
All the same reasons we did before.

And, if we end up with a baby, well that's a great bonus for an activity we would have wanted to do anyway, because we would both love to be parents!

Instead of looking at it as we "have to" have sex, we looked at the whole baby situation from a different perspective - the fact that we want this outcome is a great excuse that ALLOWS us license to have sex all the time.
Well, not that we couldn't have anyway, but maybe "reminds" or "inspires" us, would be the better term.

But if you aren't timing sex, I don't really see what the point of knowing when ovulation occurs is... I don't think there is any good reason to do much special besides have lots of sex (and take enough folic acid)
...Finally, some women can conceive perfectly fine but have something funny about their cycle that makes the 'just have sex a lot' advice not effective. Like super short fertility windows, or maybe way early ovulation that happens closer to their period than they realized (in which case maybe they weren't in the mood then).

True, there are times one or both of us feel like it more than others.

Though, notice, I didn't say "have lots of sex - if and when you feel like it". I just said "have lots of sex". That would include even when one or even both don't feel like it.

Now, granted, at first that seems to contradict everything I said earlier about doing it for fun instead of the reward of a baby, but it actually fits with my (and my wife's) general philosophy on the subject...
See, even when we don't already spontaneously happen to feel particularly horny, if either of us allows ourselves to be seduced by the other, we always, 100% of the time, end up getting into it and enjoying it. Knowing that from past experience, we are both in the habit of saying "yes". We believe this is good relationship policy, regardless of whether you are trying to get pregnant or not.

Obviously there are exceptions; cases like injury, illness, running late or needing sleep. But mostly its a shift in mindset.
Its kind of like a yummy treat. You can feel hunger, and then you make a point to find food. But if someone offers you a bite of something delicious, you are likely to accept even if you aren't at all hungry, because you know it will taste good. Similarly, when you "feel like it" you may seek out sex, but even when you don't, it will still end up feeling good, so why not accept - or even make! - the offer anyway?

So, anyway, this is what we did.
and, if that free app is actually accurate, then, based on when we stopped using birth control, it took exactly one day(!) to conceive...
...well, that would have been a little too easy.
Turned out to be a "chemical pregnancy" (an odd choice of term to mean "very early miscarriage"), only 2 1/2 weeks later, basically immediately after implantation.

And here our methods served us in an unexpected way: We had a couple of days of suspecting it might be possible from how she felt, but we didn't actually have any confirmation there had ever been conception until after we knew there wasn't any anymore - the advice nurse had her come in the the doctor's office because her symptoms could possibly have indicated an ectopic pregnancy and her HCG levels indicated she had been pregnant, briefly, but wasn't currently.
That meant a situation that for many is mildly traumatic was more of just a mild disappointment.
It turns out likely somewhere in the range of 50-70% of all conceptions end in either "chemical pregnancy" or official miscarriage.
(You see the range 20-25% a lot online, but that is only counting "medically confirmed" cases. The likelihood of being confirmed by a doctor goes up with each passing week, but the likelihood of losing it goes down, which means the majority of cases are unlikely to ever be medically confirmed in the first place. The earliest ones - those that occur in the first 1-3 weeks - often won't produce any symptoms at all and a period may not even be late, so no one ever even suspects it happened.)

So this wasn't necessarily a sign of any real problems, and it let us know we are both fertile.
In fact, supposedly fertility increases after a miscarriage, so, statistically speaking, this put us "ahead of schedule" so to speak, since its expected to take 6-12 cycles, and we were only at number 2.

Then a few months later, similar circumstances: 5 days after the soonest she might have ovulated again she started feeling nausea and sore breasts, which increased a couple days, but upon testing learned it was a chemical pregnancy.

So then we had to make a choice - statistically this is still not particularly abnormal, and could easily just be coincidence. So we could do nothing.

Then again, there was some reason to suspect (from some completely unrelated things a long time ago) that there may be a mild hormone balance issue. We could wait a month or two and run a bunch of tests and possibly have a better idea what, if any, issues there may be (but still not a conclusive answer, because medical science rarely gives conclusive answers to anything.
Or we could just keep doing what we are doing, and see what happens next time around.
For now at least, we are going with this last option.

And here's the most significant part: despite the complications we ran into so far, there is still no reason we should have done anything differently before hand. It wouldn't have changed anything. We would still be at exactly the same place we are right now. The only difference is the process would have been a lot more stressful (and we probably would have had much less sex - and the sex we had would have been less fun!)

Guess now I'll have to check back in in a few months with updates...

I started with a disclaimer acknowledging that this story is an anecdote, a sample size of one.
But that isn't entirely true.

In the US 50% of all pregnancies are unplanned.
That's about 3 million people every year who get pregnant without having done anything special to "try".
In fact, most of them were probably trying NOT to!
They definitely weren't charting, or timing sex to ovulation, or using special pro-sperm lubes
(which, by the way, have not been found any more effective than regular commercial ones in practice, in real life studies of actual people trying to conceive. The lab tests that supposedly confirm it's superiority were done in grossly unrealistic conditions that don't simulate real sex. Also, the lab tests that have purported to compare special lube to "regular" lube have used weird stuff like "warming" and "tingling" and thick gels. The ingredient lists of ordinary, inexpensive, no frills lubes is nearly identical to the specialty stuff)

So, my point in all this is this: try not to worry so much!
People have been having babies for hundreds of thousands of years. Millions, if you count all the living things that aren't quite "people" per say.
It seems entirely possible (and there is even some evidence to support this), that the mere fact of stressing about it makes it a little bit harder to actually succeed.

I'm not suggesting anyone actually change any behaviors or do or not do any particular thing.
But what I am suggesting is reframing the process, mentally, emotionally.
You probably won't get pregnant any sooner (or later) by reframing. But you are very likely to have a more pleasant experience in the meantime if you do.

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