Coital timing and frequency as part of infertility evaluation and therapy.

A panel discussion of coital timing and frequency as a part of the infertility evaluation and therapy is presented. The importance of coital timging relative to the examination of the cervical mucus in the performance of a post-coital test had several viewpoints. Some feel that the post-coital test should be done 2-2.5 hours after intercourse because that is the optimum time for recovery of the maximal number of sperm. Some suggest that 48-hour sperm viability be checked. The post-coital test is subjective at best. There is a lack of standardization of the test itself. In fact 1 laboratory has failed to correlate the pregnancy rate with the number of sperm found in the mucus. It is suggested that coital frequency be around 3 times/week and on a regular basis. Men with high sperm counts could have coitus up to 5 time/week. For most patients it is unnecessary to abstain in order to build up the sperm count. A question in treating the infertile couple is deciding what degree of oligospermia is a cause of infertility. Men with counts of 5 million have fathered children. Sperm counts vary in the same man so it is recommended that frequent counts be made over a 2 month period. In the couple with a poor post-coital test it is advised that a post-coital test be repeated every 48 hours to determine if the number of sperm stay consistent. The couple would be advised to abstain if the sperm count dropped. Otherwise intercourse every other day would be recommended concentrated in the late follicular stage. Coital timing for the regularly ovulating woman the irregular woman and the woman taking clomiphene citrate is also discussed. The regularly ovulating woman should plan intercourse between Days 9-15 of her cycle. The woman with irregular but ovulatory menses should become aware of changes in her cervical mucus. Patients taking clomiphene should be monitored for changes in their BBT. Ovulation usually take place 7-10 days after the end of the medication. However some patients have been known to ovulate soon after finishing the medication. The role of a theraeutic trial of optimal coital frequency and timing prior to an in depth fertility evaluation is briefly discussed.