[beginning fertility issues]

Information for TTC Couples...

Written by TTC Couples.


Low-Tech Ways to Help You Conceive - Chapter 7 Continued

[ Chapter 7 Beginning | Low-Tech FAQ TOC | FAQ List | Next Chapter ]

Low-Tech Ways to
Help You Conceive

7.9 Did she have an abortion(s) prior to attempting to conceive?

RAH - Undoubtedly, many women who have had an abortion or abortions wonder about the procedure's effects on their long-term fertility. This question isn't especially common on the newsgroups, but certainly it's very important to those who do worry about it. The answer, judging from the limited information available, seems to be "there's no lingering effect under most circumstances." If you are concerned, it's always wise to discuss your questions with your gynecological health-care provider. - RAH

I have recently had converstions in which the question of fertility difficulties and miscarriages following abortion came up. In these conversations, opposing viewpoints were stated. THE FIRST: Following an abortion, a person is more likely to have fertility/infertility problems; Following an abortion, a person is more likely to have a miscarriage (spontaneous abortion); Each additional abortion increases the likelihood of the above.

THE SECOND: Following an abortion, a person is NO more likely to have fertility/infertility problems; Following an abortion, a person is NO more likely to have a miscarriage, if there has been only one abortion; Additional abortions may or may not increase the likelihood of miscarriage or fertility. I recall reading about this and also having conversations about this prior to these recent ones. However, neither I nor anyone I have spoken to can "reference" the viewpoints. What I am seeking is accurate citations from literature (journals etc) or anecdotal informations from pregnancy/delivery provider (midwives, OB-GYN etc.)

I hope I am able to help answer a couple of your questions. Fertility issues and an increased chance of miscarriage are related only to previous abortions in 2 specific ways.

    1.) In performing an abortion, the cervix is dilated. If a woman has had several (generally, 3-4 or more) abortions, her cervix may have some propensity to dilate more readily (i.e. during the pregnancy, prematurely). This is called "incompetent cervix". If so, she is at risk for pre-term labor. Just because she has had one or more abortions DOES NOT automatically mean she will have this happen.

    2.) If a woman has had cervical scarring or PID (Pelvic Inflammatory Disease, severe uterine infection) she may have fertility problems or uterine scarring which could make conception or pregnancy difficult.

As you can see, there is more to the fertility issue than merely the fact that an abortion occurred.

[RAH - The above answer was provided by an MD with an OB-GYN specialty. We are fortunate to have a number of medical professionals who contribute to the newsgroups and are willing to answer questions like the above. - RAH]

Top of page

7.10 Was undue stress an element in her life?

RAH - Mentioning the role of stress in infertility and sub-fertility is one of the best ways to get a good flame-war going on any of the newsgroups! Women who have been trying for months or years to conceive, have repeatedly heard the advice "just relax, and you'll get pregnant" from (usually) well-meaning relatives, friends, co-workers, and passing strangers. I hope one service this FAQ can provide is that you should *never* use this phrase to anyone who is trying; it's a real sore point.

On the other hand, *undue* stress (the kind that "just relaxing" won't help anyway) can and does interfere with female fertility, primarily by disrupting the cycle and causing delayed ovulation or even anovulation.

The effects of stress on men are less well-researched and poorly understood (as seems to be the case with so many infertility issues -- the gender-gap persists across the spectrum.) It's plausible that extreme stress can interfere with sperm production or with proper reproductive-system function generally, but the evidence so far is more anecdotal than clinical.

I am including a variety of posts on this subject, so you can understand the emotions as well as the issues raised by the question of stress. - RAH

I'm curious how stress plays a part in conception. If all parties are "there", shouldn't it work anyway?

I think it's not a factor unless stress is unusually great -- to the point of causing anovulatory cycles. In a lesser way it can delay ovulation during a particular cycle; this isn't infertility per se, but it can mess up your attempts to get the timing right!

My husband and I have been trying to conceive for 7 months. My friends tell me that 6-8 is average and that I shouldn't worry. They also tell me that they conceived when they relaxed and forgot about having a baby but I can't seem to do this. Could anyone please help and tell me how to relax.

I'm sure your friend's advice was well-meant, but I am equally sure that those of us who've had infertility problems will see red with that kind of statement. Stress can inhibit fertility - but we are not talking about being stressed because you cannot conceive. We are talking mega-stressful job, "on the verge of a nervous breakdown" stress. People over-use the expression "Stress". You are not "stressed", you are anxious, frustrated, disappointed etc. that you are not pregnant yet. If fertility went out of the window as soon as a woman actively wanted a baby, the human race would have died out!

I used to think that the stress of wanting a baby would stop my conceiving and worried about this particularly because I suffer an anxiety problem. I did find stress affected my fertility - my job was so bad, my periods stopped and I stopped ovulating. In such circumstances, stress can stop you getting pregnant, but that is rather extreme.

It can take over a year to fall pregnant, even without true fertility problems. I took 14 months with [baby], but during that time I did have the "killer job" and I suffer endometriosis (which has now gone). Most doctors [in the UK] will not see you re. fertility until you have been trying for 2 years, but that depends on your age and health. It does no harm to have preliminary investigations after a year (husbands sperm count/motility, ultrasound on you to check your tubes are OK and the ovaries look OK etc., checking your hormone levels to see if you're ovulating). In the meantime, hang in there. It's not your fault you haven't got pregnant yet, and the majority of us do have babies in the end. And if you do have fertility problems, there is lots they can do to help.

I am posting this seperately because this kind of theory has come up on several threads and I have noticed the number of times people have said "My friend got pregnant just after she adopted" or "My friend went for IVF and found she was pregnant" or "She gave up on IVF and discovered she was pregnant".

The assumption in all these cases is that the person relaxed, and it was the reduction in stress that caused the boost in fertility.

I too had this kind of theory, but after 14 months of trying, I began to wonder if anxious people ever get pregnant. They do. So do people who can think of nothing else except getting pregnant, and who are so stressed out by infertility they lose 100 lbs (a friend of mine did this). Many of my infertile friends who eventually got pregnant have said "I must have relaxed" and attribute their pregnancies to this, but when I actually think back to what they were like just before the pregnancy, I can't say they were relaxed. Quite the opposite in fact.

Now, at the risk of being flamed, I must say it is not true that stress does not affect fertility. It does. The normally fertile man's sperm-count can go down if he is in extreme *physical* stress, such as training for the Olympics; and the normally fertile woman may stop ovulating and menstruating in similar circumstances. During wartime, it has been observed that peoples fertility seems to go down, but then most people are somewhat preoccupied during a war. However, this is not *infertility* - it is just the temporary reduction of normal fertility during a time when the body is trying to conserve energy. If stress were ... causing a reduction in fertility, all it would serve to do is to lengthen the time people have to try for a baby, as the statistical likelihood of getting pregnant each cycle would be a little less. The statistical likelihood of a woman with one ovary getting pregnant is reduced, but many women with only one ovary get pregnant perfectly normally. This is not infertility, I have discovered.

So if stress is not the cause of true infertility, why do these people get inexplicably pregant after IVF or adoption (and there is evidence that it happens frequently enough to be statistically significant)? Well, my friends tell me that the most common "cause" of infertility is the so-called "unexplained infertility". In other words, no one knows *why* they are infertile, so no one can say what their chances were of getting pregnant. It is possible that unexplained infertility is a temporary condition, and they would have got pregnant after a given amount of time, regardless of IVF etc. Things like IVF work by completely blocking the natural cycle and all the drugs make conceiving while on IVF, naturally, very unlikely. The couple can only get pregnant after they have completed IVF. Perhaps with hindsight, the doctors were too hasty to label them infertile and give them IVF, but you cannot tell that until afterwards.

I don't know what people think of what I am saying. It's just that the experiences of myself (I got pregnant the week I was due to go to the infertility clinic), my friend who got pregnant between visits to the IVF clinic and another friend who couldn't proceed with IVF because she was having twins. All of us were totally stressed out, and all of us got pregnant. We were all told it was because we relaxed, despite all evidence to the contrary.

One thing that I want to beg you -- is please, please don't repeat the old wives tale that stress, or focusing on conceiving, can impair your fertility. It won't (unless you are so horribly stressed that you stop ovulating, which is unusual, but happens). It is good not to be too focused or stressed, but not because it will hurt your fertility; rather, it can affect your relationships, your life, your health -- other important things!

I'm on a pregnancy-after-infertility notesgroup and there was a thread recently on stress and conceiving. What was funny about the thread was how many people had finally conceived during one of their most stressful months. It was really amazing! I think I had beat myself up for a while trying to avoid stress, and it really didn't make much difference (although I had some nice vacations and romantic weekends that were great -- didn't lead to conception, though). I, too, conceived during one of my most stressful cycles, stressful not only because of some external issues that were making me crazy, but because the tension of trying to conceive was at an all time high! Still, it was the lucky month!

If I hear that "just relax and you'll get pregnant" crap again, I will personally vomit on your shoes. How's that for flaming?

Instead of trying to relax, I'd start looking into whether or not there may be a problem. While most doctors will tell you to try for a year, you can, and should start charting your fertility signs now. If you can determine when you ovulate, you can better time intercourse, and you can also determine if perhaps you are NOT ovulating. If you are not (or if you are over 30), you should see a doctor as soon as possible. (All the relaxation in the world won't help if you have a physical problem.) Also, if you think there may be something else hindering fertility (very painful periods [possible endometriosis], irregular periods, history of pelvic infections), I would get it checked out by an MD.

It can take a lot longer than you initially plan on to get pregnant. There are all sorts of things you can do (many are listed in this FAQ), but above all you have to let your body do what it knows how to do and keep living your life, or in other words, chill out. The stress you put on yourself will not help you achieve your goal. Think about enjoying these last few months before you get pregnant, because kids sure change your life!! If you already have one child, think about it as more time to enjoy that child without a baby around. In time you will probably get pregnant and those frustrating months of trying to conceive will be a fading memory.

If anyone out there knows anyone with fertility problems, please don't tell them to relax. It's like telling someone who's depressed to cheer up (oversimplifying a complicated problem). First of all, most people with fertility problems have a physical problem that no amount of relaxation will cure. Secondly, people can't relax on command.

Yes but the question wasn't "is stress _always_ the cause of infertility" it was "can stress be a factor" and the answer to that is yes. I'm majorly affected by stress. When I'm stressed I don't ovulate. If I'm not ovulating I can't get pregnant. But I DON'T have a treatable, physical condition.

So ... yes, grief could be a factor, but its worth making sure that there are no physical reasons for the delay too.

Top of page

7.11 Did she try taking Robitussin (guaifenesin) cough syrup?

RAH - Cough syrup for fertility? Sounds peculiar, eh? Maybe so; but there's evidence that it can help! Specifically, guaifenesin (the principal active ingredient in plain Robitussin cough syrup, is a mucolytic agent, meaning that it liquifies cervical fluid in the human body. Plain Robitussin (i.e., the Robitussin that's not followed by any initials) is an expectorant, meaning that it acts to liquify your respiratory mucus so you can cough it up easily. (Sorry if this is grossing anyone out :-)).

The reason Robitussin (guaifenesin) fertility in women is that it helps liquify ALL bodily mucus -- so, the cervical fluid is thinned in just the same way as respiratory mucus. This can be important in women who have thick or scanty cervical fluid, since it allows the sperm an easier and quicker path into the uterus and beyond. The clinical evidence in favor of Robitussin is not vast, but according to the newsgroups it CAN work -- and there's no risk in trying it (unless you can't tolerate cough syrup for other reasons.)

The usual suggested dosage is the same as specified on the box for coughs. Be sure to get the Robitussin with no initials after the name (e.g., no "Robitussin DM", etc.) Many of the initials-types contain antihistamines, which have the opposite effect -- they dry up cervical fluid! You may also be able to buy other brands of guaifenesin, but be sure it doesn't contain other "conception-unfriendly" active ingredients. - RAH

Robitussin, a trade name for Guaifenesin, is a mucolytic agent. It thins out mucus in the sinuses, nose, bronchial area and cervix. This makes it less thick, less gummy and more liquid. Some women's cervical [fluid] is too thick and gummy to allow sperm to penetrate. By using a mucolytic agent (also called an expectorant) during the 6 days prior to, and day of, ovulation one may facilitate sperm transport and increase the chance of conception.

(Why the progesterone in oral contraceptives keeps conception from occurring -- it makes a thick cervical ... plug as a barrier to sperm.)

The role of guaifenesin (tradename Robitussin Expectorant, and a common ingredient in cough syrups and OTC multi-symptom cold relievers) is that it is a mucolytic agent. It makes viscous mucus produced in the sinuses, nose and chest (and cervix) thinner, more cervical fluid and therefore easier to drain. In a lecture I attended on the treatment of infertility, the gynecologist said that women whose cervical [fluid] is too thick and too gummy to allow sperm to penetrate are advised to use guaifenesin around the time of ovulation to help reduce this obstacle to fertilization. Another way around this thick cervical [fluid] problem is artificial insemination where the concentrated semen is introduced to the uterus with a syringe via the cervical canal.

Guaifenesin is the medicinal agent in Robitussin that thins mucus. That is why it is useful for upper respiratory infections and has some use in patients who have very viscous cervical [fluid]. Unfortuately, problems with cervical [fluid] are often the tip of the iceburg and can be associated with ovulatory dysfunction, cervicitis, and antisperm antibodies to name a few. Obviously, if one of these problems exists, guaifinesin is not the solution.

What kind of Robitussin? There are several varieties out there. This is interesting!

Hi! Get the plain jane Robitussin, no initials after the name. All the others contain additives such as antihistamines and dextromethorphan (sp?), which can have the opposite effect as that desired.

No guarantees here, but the recipe is to take 1-2 teaspoons daily for the 5 days before ovulation and the day of ovulations. Also the Robitussin should be the formula which contains an expectorant.

My OB/GYN said to take 1 tsp. [of Robitussin] twice a day every day. I am finally starting to get used to the nasty tasting stuff after 2 mths.

I took 2 tsp [of Robitussin] 3 X daily for 1 week starting about 5 days before expected ovulation. Don't know yet if I have conceived... but I didn't cough all month :)

Also, for those who just can't stand the taste of the syrup, you can get guaifenesin in liquid-gel-capsule form.

Top of page

7.12 Did she use any douches at or near the times of (attempted) conception? What was used as a douche?

RAH - Douching is not good for vaginal and reproductive health in general; it is a particularly bad idea for women trying to conceive. Among the problems douching creates: altering the pH balance in the vagina (sperm need a narrow range of acidity-alkalinity to survive); flushing away cervical fluid; and possible introduction of infectious agents into the reproductive tract. As Toni Weschler says (after a long list of problems with douching): "Other than that, douching's no problem!" (p. 155, _ TCoYF_). NOT!!

Bottom line: There's no good reason to douche, and many good reasons to avoid douching. - RAH

Top of page

7.13 Does she have a retrodisplaced or "tipped" uterus?

RAH - A not-insignificant proportion of women have this condition, in which the uterus is tilted toward the rear (spine) instead of the "normal" angle, tilted toward the front (abdomen.) Years ago, women with this condition were thought to have severely-reduced odds for conceiving. This is no longer the case; but there is some evidence that a tipped uterus can make conception a bit more difficult in certain cases.

The most common adjustments recommended are in best position for intercourse, and best postion for lying down afterwards. Some couples have reported better results with rear-entry intercourse than face-to-face or other positions; along the same lines, lying on your stomach, with pillows under your pelvis, has been suggested over the usual on-your-back advice. At least one authority (Dr. Landrum Shettles) also recommends these two adjustments. Not every woman with a tipped uterus has had trouble with face-to-face intercourse and/or lying on her back, however.

The best advice, in my opinion: If you know you have a tipped uterus, try it both ways! - it can't hurt, and might help. - RAH

I do know that [for most women] if you lay on your back with a pillow under your behind/upper thighs for about 15 to 20 minutes afterward, you will maximize the flow of semen around your cervix.

This is exactly the opposite of what my doctor told me. She said that lying on your back after intercourse is for women with "regular" uteruses. Those of us with retroverted/tilted uteruses (uteri?) should lie on our stomachs for 30-60 minutes after sex. I've only been pregnant once, but it did occur after making love in the missionary position (for depositing sperm closer to the cervix), then turning over onto my stomach for an hour. Some in this group have suggested, though, that the rear-entry position is recommended for a woman with a tipped uterus.

I'm one of those who posted that rear-entry intercourse and lying on your stomach afterwards are better, if you have a tipped uterus. My understanding is that the uterine retrodisplacement causes the angle of the cervix to change also, so that the posterior fornix (the "dead end" space at the very upper end of the vagina) becomes deeper. In the missionary position, and in lying on your back afterwards, this means that more semen might collect in that area and less of it get through the cervix. Rear-entry and lying on your stomach is supposed to make the semen flow out of this dead-end and across the cervix, as I understand it.

Kind of hard to describe this without a diagram... I hope that's clear enough!

I posted a query on this same issue earlier this week. I have a tipped uterus, and my father recalled that my mother (who had three children) was told that due to her tipped uterus, she would have difficulty conceiving. I saw my RE for the first time today, and he told me that in the sixties they did think that uteruses that were tipped to the back correlated with a difficulty in conceiving. Now they don't think the two have anything to do with each other. However, tipped endometriosis is more common in women with tipped uteruses.

Having a tipped uterus (retroverted) is kind of like being left-handed. I'm left handed and certainly don't consider myself abnormal. It is true that some uteri that are tipped backwards are in that position because of adhesions (scarring) in the pelvis that may be due to a past infection or endometriosis. This is not the case for most patients, however.

If a uterus is tipped so much that the cervix is in an almost vertical position, it is possible that sperm may have a hard time getting into the cervix with intercourse. I've only seen one or two patients like this though and do not believe this is a problem for most patients with tipped uteri.

Well I'm left-handed w/ a tipped uterus so does that make me doubly abnormal :-)? Seriously though, my mother says that the only way she over came her tipped uterus was a suggestion at a New Years Eve party.

Imagine a room full of friends imbibing in Manhattans for several hours when the conversation turns to the only couple in the room w/o children. Everyone in the room knows that the couple have been married for 10 months, they are in their late thirties and they are desperate to get pregnant. Being the late 1960's the woman in question takes the news that having a severly tipped uterus as a virtual death sentance to her dreams of getting pregnant. In the good cheer and good friendship the couples try and come up with a position to keep the sperm in the glass as it were. So after many suggestions, and a few more Manhattans, my parents went up to the master bedroom in the hosts house and VOILA!!

I was born Sept 27, 1966 and it took 25 years to understand why my godfather winked everytime he said, "Don't listen to them kid, I brought you into the world."

A retroverted uterus shouldn't have any effect on your fertility. I have one and we conceived our first month of trying. I've read the propping on a pillow case for anyone, and I did that as well. The main concern is once you are pregnant, your uterus must revert itself by the second trimester or you may have to have a procedure done to correct it. The danger is the uterus becoming impacted in the pelvic cavity as the pregnancy progresses. Most times the condition corrects itself naturally.

*chuckle* Well, I'm not believing I'm posting this but FWIW, I have a tipped uterus, and had a very difficult time conceiving my 1st pregnancy. My then-husband and I only did missionary style. My 2nd pregnancy with my new husband happened 2 months off the pill. I know for a fact it was hands-and-knees position. Perhaps this has some validity? (I know, I know, it's a far reach, but I remember what it's like when you are trying to have a baby and you are disappointed each month when it doesn't happen. I listened to everyone's advice, though I didn't actually try many of the suggestions. My favorite one I laughed at was to stand on my head for 20 minutes after intercourse. Egads!)

Of course, this is my personal opinion, and I have no medical education at all. When my 1st husband and I decided to try for a baby, it took us 2.5 yrs. to conceive. We only practiced the missionary sexual position. However, my 2nd pregnancy only took me 2 months to conceive. We only practiced rear-entry sexual position (due to a myth saying this was a good position to have a boy.) I'm not positive, of course, that the difference in sexual positions actually made a difference. I do have a new husband, and this is his first baby. But ever since the doctor told me that I had a tipped uterus, I've had the same theory myself, and even posted to misc.kids.pregnancy about it. It sure seems a real possibility, at least in my case. And I do know that if I ever decide to have a 3rd child, we will definitely use rear-entry again. It just seemed to happen so much easier the 2nd time around.

: I was told before conceiving my first child that I had a tipped : uterus. My OB told me that the only significant thing about this was : that it made conception more difficult. It took us 9 months to get : pregnant the first time....

: We're working on number 2 now....it's been a year and a half so far. : I don't know if our troubles *are* directly related to the tipped : uterus or not...we're scheduled for fertility counseling in 2 weeks.

I've heard that while some doctors were once taught that tipped (retroverted) uterus might impact on conception, most now don't think that is the case. The most I've heard is that you might want to try a different position for intercourse. For most women, the missionary position is considered best; for us with a tipped uterus, some suggest a hands-and-knees position, with your shoulders as low as possible.

Discuss with the doctor in any case - medical opinion may have swung back the other way again!

FWIW: I've been pregnant twice. I don't remember how we caught the first time (ended in miscarriage), but we caught [our baby] in the missionary position - I know that for a fact :-)

[Re: Lying still after intercourse]: Yeah...I did it! It was suggested to me by someone, plus I have a book on getting pregnant that recommends it. I lay there for 30 minutes each time! (Very boring!) Still don't know if it worked, though. I also *thought* I heard that if you had a tipped uterus (which my doctor told me I do), you should lie on your stomach instead of your back, but I wasn't sure. So, I switched off...lying on my back every other time & my stomach every other time. Probably obsessive, but I didn't want to take any chances if it would help me conceive!

I tried staying horizontal this cycle (never tried before) for about 30-45 min, and guess what, It worked. I just found out Tuesday night that I'm pregnant. I also have a tilted uterus, and I had never heard about lying on your stomach. But I had heard that rear-entry sex was the best position for that. And we did that too. BTW, this was our 5th cycle of trying.

Hi all -- I was the person who mentioned that lying on your stomach can help if you have a tipped uterus. The reference to this is from Dr. Landrum Shettles' book _How to Choose the Sex of Your Baby_. (This book contains a lot of suggestions for fertility-enhancement in general, as well as the specific info on gender-selection.) Shettles says that lying quietly on your stomach for 15 minutes after intercourse will help the semen enter the cervix instead of collecting in the posterior fornix (the "curve" in the vagina just below the cervix), if you have a tipped uterus.

Other sources I have don't mention lying on your stomach specifically, but most all of them do recommend lying horizontally and quietly for up to 1/2 hour afterward. So, whether it's stomach or back, it's bound to be better than going to the gym :-).

There's also evidence that the rear-entry position can help for those with tipped uteruses. My wife has a tipped uterus, and I'm fairly sure that both rear-entry and lying on her stomach (along with some other methods) helped us conceive on the first try this time!

I too have a tipped uterus and have conceived on the first try all three times I have gotten pregnant (2x trying, 1x not). We are currently trying again, and I think that we may have done it again, without rear-entry.

According to my midwives, I have a "tipped" uterus. We had no difficulty conceiving (twice) without using the rear-entry position (which is very uncomfortable to me!).

I have a tipped uterus, too. According to my doctor the idea that a tipped uterus makes it difficult for a woman to get pregnant is a myth - every patient she has referred to the fertility clinic who blamed the problem on a tipped uterus ended up having some other problem (or her partner had some other problem) that was the real cause. At any rate we didn't have any trouble getting pregnant, using face-to-face position.

My understanding is that a tipped uterus may inhibit easy pregnancy. My experience is that it had nothing to do with anything.

Don't know exactly how *tipped* mine is, but several Dr.s mentioned it. But I got preg both times practically as soon as we tried ( or stopped trying not to, depending on how you look at it). And pregnancies were easy, normal no-drug deliveries for both. YMMV.

Here's another response for you re: tipped uterus. I have one, and I conceived using the good old missionary position, aided by elevating my pelvis on a pillow during intercourse, and on two pillows afterward. Rear-entry isn't comfortable, probably b/cos of tipped uterus getting in the way.

(We also used the cervical [fluid] signals, but not BBT).

I have a very tipped uterus actually so much so that my last doctor peferated the uterus during a D+C but thats another story. I have been pregnant 3 times (2 miscariages). Position didn't matter for us. We found increasing frequency [of intercourse] to work; however, it couldn't hurt to try [elevating your pelvis on] the pillows if your not uncomfortable that way.

I am currently pregnant for the fourth time (one miscarriage). I know for sure the first time and this time the "missionary" position was successful. Not so sure what position numbers 2 & 3 resulted from! First and second pregnancies happened the first month we tried--third took 3 + years of trying with no fertility enhancing methods used beyond maximizing timing. This pregnancy happened 3 months after miscarriage. We did go through basic testing for hormone levels, sperm levels, etc., with everything appearing to be great. The tipped uterus was not considered a big factor by my ob\gyn, who is a fertility specialist.

My uterus is not in the normal position. It is literally tipped *forward*, that is folded nearly on top of itself toward my navel. I've been told this by several OBs who say that it shouldn't affect fertility (I do have one child) and straightens itself out during pregnancy. However, we're having a hard time getting PG right now and I was wondering if I could do anything to help the process given this condition.

I don't find any specific recommendations for your condition in my references here. I would suggest that you lie on your back after intercourse with your pelvis elevated (i.e., pillow under the butt), and your legs elevated higher than your pelvis. This will help gravity bring the semen to your cervix more rapidly and will also bring your cervix more nearly "horizontal."

Also, if you can manage it, try having an orgasm *after* your partner ejaculates. There is clinical evidence that this can bring the cervix into contact with the semen and draw it up into the uterus.

Top of page

7.14 What kind of underwear did he usually wear? (boxers / briefs / bikinis / none) Did he switch to a different type before conception? How long before?

RAH - From this section through the end of Part 7, the discussions and recommendations are focused mostly on the male-factor side of the equation. Before I continue into the specifics, a general observation: Best estimates are that 50 percent of all fertility problems are partially or entirely due to a problem on the male partner's side of the couple. Despite this fact, the research and evidence, both clinical and anecdotal, on reasons behind and remedies for male-factor fertility problems is nowhere near the evidence on the female side. (The reasons why this is so could fill a book, and would be outside the scope of this FAQ besides!) My point is that the sections following rely heavily on anecdotal evidence; take the discussions and recommendations for what they are worth to you.

On this particular section: The single most-common low-tech fertility recommendation for men -- so common that it's entered the realm of popular culture -- is to wear boxer shorts instead of briefs underwear. Men don't spend much time talking about either fertility problems OR their underwear, so no one can say for sure how much of a difference this advice makes from the "user's" point of view. Judging from the anecdotal evidence supplied by their female partners, though, the recommendation seems to work -- often enough that it's worth doing!

The reasoning behind the switch-to-boxers advice is sound: The testicles need to be cooler than body temperature in order for sperm to be manufactured and stored. (Temperature recommendations vary, but I have most often seen the figure 92-93 degrees F. and below as the "safe zone" for testicular temperature. Briefs and tight underwear will keep the testicles pressed closer to the body, and also keep the penis pressed against the testicles in front and underneath them; thus they are kept too warm on all sides, so to speak. Boxers allow the testicles to hang down away from the body, away from contact with the groin, and allow the penis to hang down sparately from the scrotum; the result is cooler temperatures throughout the genitals.

How quickly will switching to boxers help sperm count and quality? The basic fact here is that it takes 70 to 80 days for a sperm cell to mature in the male system. So, if wearing briefs (or any other heat-producing activity) has killed off any or all of the sperm, bringing male fertility to its maximum will take that long (although some improvement may be detected earlier). This means wearing the boxers, staying out of hot tubs, and so on will have to be at least a 2.5-month commitment on his part.

So, if boxers are so great, then why don't all men -- at least, all men trying to conceive -- wear boxers? Women on the newsgroups regularly ask "How can I persuade my partner to get rid of his briefs?" The basic problem that many men have with boxers, is that the very aspect that makes them good for fertility can make them uncomfortable to wear! The testicles are one of the most sensitive parts of the man's body to pain, and the more they hang down aways from the body, the more easily-hurt they are. (Any man who has played sports knows the agonizing feeling of taking a "hit" in the genitals -- it's almost preferable to break a bone, at least considering short-term pain!) Briefs, by keeping the testicles out of harm's way, can help avoid or minimize this problem. Add to this the facts that most men grow up wearing briefs and that old habits are hard to break, and the reason why many men resist switching becomes clear. My totally unscientific impression is that a majority of (American) men wear briefs. (In recent years it's become "cool" for teenage boys and young men to wear boxers; maybe this will help reverse the decline in fertility we've witnessed over the past half-century!)

Clearly of course, briefs aren't a universal death-sentence for sperm; if they were, a lot fewer babies would be born, in the Western world at any rate. My opinion is that briefs probably lower the sperm count in almost everyone, but that many men have enough "reserve production capacity" that they can afford to lose a few. If sperm counts are marginal, or if the briefs are particularly tight, or any number of other factors are at work to raise testicular temperature, then underwear can become important.

Wearing boxers is a difficult thing to get used to, for men who haven't always worn them; it requires learning how to sit down all over again, for example. Many men give up on boxers after just a few days of trying them. My opinion is that switching underwear is a small price to pay, if you want to maximize your fertility chances. Give them a try for a few weeks, and you might find they are more comfortable than you thought. Just don't wear them if you're going to be playing contact sports! For the benefit of you consumers out there trying to find comfortable underwear, I've included a long post I made on alt.infertility comparing different types. - RAH

We had asked our doctor this, and we have since read about in a few different places. We were told that the whole male reproduction system is extremely heat-sensitive--the testes are outside of the body in the scrotum for maximum cooling efficiency. If the temperature is raised by even a couple of degrees, the male body completely shuts down in it's sperm production. Wearing tight briefs or bikini-style underwear can easily cause this temperature raise.

My best friend's brother and his wife were having problems conceiving and this was determined to be the cause. He had to have an icepack put someplace very uncomfortable in order to lower the temperature quickly enough for them to try by her fertile window.

[RAH - The icepack, if it helps at all, will take a longer period of time than one cycle; it takes about 2.5 months for sperm to be replaced. See Sec. 7.20 for discussion. - RAH]

I had to go to the doctor for an ear infection Monday, so while I had her "ear" so to speak, I asked about this, as well as other general fertility questions. She says the switch-to-boxers advice is now pretty standard medical advice for couples who are in our situation (no diagnosed fertility problems, just want to increase the odds.) In fact, it is *the* most commonly recommended change for men; for women BBT charting is the most common first step. (She didn't mention the ice, though :-) ).

Incidentally, tight pants like Levis can have the same effect, apparently.

After 6 months of trying, my husband switched from briefs to boxers. Two months later, I was pregnant and he swears that it did the trick. I won't even attempt to convince him otherwise.

We took 3 years to conceive our first baby and although hubby's sperm count, etc. was fine the doctor did tell us that heat really has a go at the little fellas! That's why wearing boxer shorts is often recommended.

"On a totally unrelated subject - sperm count. For what its worth I was told that my motility was low (15%) about eight weeks ago (my count at 40 million per ml wasn't that startling either!!). Since then I've only had showers, worn boxer shorts and taken vitamins A,C,E (with selenium) and also zinc. Just had another test - 120 million per ml and 50% motility. It's not going to revolutionise the world, but I thought it might give some hope to others..."

That's great! My husband switched to boxers and doubled his motility -- it must work! I will start him on vitamins tomorrow!

So now the question I have is, do boxers in some magic way promote motility as well as count? Any clues on how, if possible, to improve motility.

And, out of curiousity, would the boxer issue be a cumulative one where one should have to wear them for a while to see changes (in other words, not just for the few days before ovulation).

The DH's count seems like a good vote for pouches [briefs with a pouch in front, to hold testicles a little farther from the body], except for the motility problem.

Can't help you on the first problem -- none of my references state exactly which sperm parameters are affected by heat, only that it does cause overall "useable" sperm to decline.

On the cumulative thing -- the answer is that it IS cumulative, but only slowly, since the life-cycle of sperm is so long: 70-80 days. So, if he were to switch for a few days, then the effect on the sperms produced in those few days would be immediate -- but it would take them weeks to get through the epididymis and out to where they can be launched :-). So, every day of cooler testicles helps, but it's not an immediate payoff, and switching right before ovulation won't help for that month.

I guess you've heard the boxer/brief debate? My husband wouldn't do the boxer thing (his "boys needed more support") and his count was still good.

We're not pg yet, but DH has been wearing boxers for 2.5 years and seems to have adjusted just fine. The thing is not to wear *tight* underwear. Besides it couldn't hurt, and silk boxers make a fun gift :-)

On the subject of boxers - We had the advantage (if you can call it that) of having friends who were trying to get pregnant for a year. She conceived a month after he switched to boxers. This was before we had started trying, so by the time we did my hub was prepared for the switch.

Yep, I have one silk pair that I really like; my wife doesn't like them because they were a gift from a previous girlfriend - so I said she should just buy me some new ones :-).

PS Hint to your wife that silk boxers make great Valentine's Day gifts :-).

On the subject of boxers, my hubby doesn't like the woven cotton ones. He only likes knit ones. The knit ones are out of the same type of material that a t-shirt is. Target is one of the few places I have found that carry knit boxers. On the other hand, he has been wearing them for almost two years now and I am really not sure they have helped. I think they did make his varicoceles more painful before he had the surgery, though.

I have some ... that my wife bought me at Target. I agree they are more comfortable than the standard boxers if you're used to briefs; but they are also tighter -- sort of in-between the boxers and briefs in terms of support.

I have seen some recently that are more like bicycle shorts. I would definitely think those would be too tight. I don't really think these knit ones are much tighter than the regular boxers (but then I am not the one wearing them, am I?).

Well, I can only say that once my husband started wearing boxers and keeping out of hot tubs we were able to conceive. And so did his best friend. It seems to be the least invasive method of encouraging fertility so why the heck not try it!

I bought boxers for my husband the first time we were trying. He discovered that they were unacceptable for bike riding. We were pregnant well before the 72 days it would take for that to help, anyway. (He only rode about 6 miles a day, for transportation.)

He wore briefs before first attempt at pregnancy, switched to boxers for several months, then went back to briefs. It didn't seem to affect our fertility either way.

My second child was late in getting started due to poor motility. There was an improvement by switching underwear! The testicles naturally move up or down to maintain the proper temperature but tight underwear can inhibit that and "cook" the sperm.

We have been trying for 6 years, now on our 4th IUI. My husband will not change to boxers, plus his urologist said it was not necessary. He is willing to do anything except change to boxers. It is frustrating, but we are still hopeful.

[follow-up]: Roger, my husband refuses to wear boxers because he says they are too uncomfortable. He has low counts that vary from 1.4m washed to 27m. His dr said boxers wouldn't make a difference, tho I disagree.

But I guess the dr is right, because after 6 years, and 4 IUI's we found out yesterday that we are pregnant!!!! And it was from the lowest count we have ever had, so miracles do happen.

OK, I *know* April Fool's Day might not be the right time to ask this, but after doing the mad dash to the hospital with a semen sample this morning, my husband and I were trying to figure out this boxer thing . . . Please indulge me : )

Okay, it's April 2nd, and I'm waiting for my printer to come back from the shop, so let me give you what is probably a much-longer answer than you really wanted :-).

He's trying to figure out if boxers really keep things cooler. He finds that boxers seem warmer to him because there is more skin-to-skin contact, as well as some logistical problems. He thought the argument against briefs was that they keep everything up and in too tight and warm. But what about underwear with a pouch? He says that lifts and pulls forward and seems to give a little fabric between the genitals and his body keeping him cooler, but it's certainly compacted and supported more than boxers -- something he prefers in terms of feel, and I must admit that I prefer in looks.

I'm particular about underwear, so I've tried lots of styles. My DW is also very particular about underwear -- hers, and mine :-).

The general advice to switch from briefs to boxers is based on good, sound physiology: Briefs usually do hold the testicles closer to the body for most men, and the 98.6 degree-F. temperature is too warm for the sperm cells, which tend to flake out over 92-93 degrees. So, *if* boxers let the testicles remain farther away from the body, then they should help.

All the expert opinion I've seen, and all the major fertility resources, agree that boxers are supposed to work this way. However, not all men are the same, and this wouldn't necessarily be true for your DH.

I have to say that boxers definitely are cooler than briefs for me; however, I think he is onto something with the pouch-type briefs, as I'll explain. Also, you mentioned "logistical" problems -- does this mean the problem of, umm, sitting down on things you don't want to sit on? The trick to sitting down with boxers on is to do it slowly, keeping your legs apart. It does take a little time to get used to them...

Here's my experience, FWIW (and bear in mind that I have no male-factor problem, so feel free to copy my example!): I have tried all kinds of underwear -- briefs, boxers, you name it. (I have come to the conclusion that there's no such thing as all-day-comfortable underwear for me... but, hey, we all have our cross to bear... :-) ).

Here is how I would rank them in terms of support and in terms of how cool they feel to me:

    * "Regular" Boxers -- not much support at all; definitely cooler
    than most briefs. I wear them about half the time, more in
    the summer, except during sports or when I need more support.
    (Playing soccer with boxers on is a *bad* idea!)

    * Knit Cotton Boxers -- I just tried these, thanks to a
    suggestion from someone on this group -- support is minimal
    but better than regular boxers; coolness is similar to regular

    * Boxer-Briefs -- these are the new kind that look like briefs
    but extend down the legs -- as you would think, they are
    in-between boxers and briefs on both support and coolness. I
    wear these fairly often during the winter; they definitely
    keep your *thighs* warmer than any other underwear.

    * Pouch-Front Briefs -- I think your DH has a good point about
    these! They are definitely cooler than any other kind of
    briefs, and might be cooler than boxer-briefs. On support,
    they are also pretty good. I wear them a lot more often than
    regular jockey briefs, for the same reasons as your DH.

    * Regular Jockey Briefs -- These are definitely tight (we called
    them "tighty-whities" in high school :-) ), and therefore keep
    the testicles and everything else down there warmer; they do
    give a lot of support, which is why most men wear them, I
    think. Personally, I have never liked them much, not since
    puberty anyway; I've tried zillions of brands, and only Calvin
    Klein fit well, but that's just me, I guess.

    * Bikini Briefs -- These are the opposite of regular boxers:
    tightest of all, and also maximum support. They are the
    male-underwear equivalent of sports bras for women, in that
    they operate by squishing everything totally flat :-).
    Personally, I find them too tight to be comfortable, but my DW
    likes me in them so I'll put them on for special nights

    * One more type: They do make men's thong underwear, believe it
    or not! I have one pair, and they aren't bad in terms of
    support and coolness. However, I have never gotten used to
    feeling like I'm wearing dental-floss in the back :-). (For
    you women who wear them, I admire your fortitude; and *please*
    don't let anything I say discourage you :-) ).

Obviously, everybody's mileage may vary! My adivice is to buy several different kinds, and experiment. Your DH might want to try the boxer-briefs, for example. Overall, if he wants more support than regular boxers, I'd recommend either the boxer-briefs or the pouch briefs -- neither will be as bad for sperm as the regular briefs.

I hope this helped someone out there...

Can you tell me who makes these [pouch-front briefs] and where (chain store wise) 'we' might be able to find them.

Where to find them? Wal*Mart has Spaulding ones I think, but the material isn't as good and the seams are a little itchy. I'm not sure about the Hanes and Fruit of the Loom brands since my DH tired of them quite a while ago.

The one's my DH prefers are Jockey, either the brief or the style that somes down the leg a bit (very sexy). We've found them at department stores such as Macy's and J.C. Penny. For boxer-briefs, he seems to like Calvin Klein, but he still prefers the support of the pouch.

BTW, the logistical problems with boxers are sitting on [the testicles], having them stick to the thighs when sitting for long periods, and with the shorter ones, falling out completely. He also feels that he has to "adjust" himself much too often. He also thinks ones that don't stretch have a tendency to bite him in the balls.

I agree completely, those are all drawbacks to the boxers, especially the "fallout problem" with the short ones. There is a brand, Joe Boxer, that makes them with cool patterns like sword fish and blue whales, but for some reason (saves money, probably) they are too short. It doesn't do much good to wear underwear if they don't cover you up :-). So I mostly wear the longer ones that have boring blue & white stripes, or whatever.

And we won't get into the other "fallout problem" -- that gap in the front, which is an especially big pain if you sleep in your underwear. Those flys (flies?) are pretty much useless, anyway. (I always turn my boxers a little off-center to avoid the problem.)

BTW, the solution for that seam that bites him in the balls, is to wear them a little lower on the hips that he would briefs. That takes a little getting used to, also.

Well except for Roger, many of us have had to use major powers of persuasion to get the hubby to wear boxers. Well it looks like they have a new underwear for men out that may help stop the fight. (why do some men act like changing to boxers is just as bad as us women getting an HSG or Endo Biopsy done or maybe even worse?)

They are calling them boxer briefs, and they look like they may be as roomy as boxers but it looks as if they had a pouch to hold the little guys up (but still loose) from falling down the leg (I am assuming that your husbands complain about this too). Anyway, I think they may have the cooling benefits of boxers, but the comfort benefit of briefs.

Yep, I agree ... these are really a good compromise (as well as the pouch-front briefs mentioned earlier.) The boxer-briefs are not nearly as tight as briefs, but they aren't as loose as boxers. There are two types -- one type looks like regular briefs, but they have a leg extension that goes down to about upper-thigh length. The other type looks a lot like bike shorts; they are made of spandex and cotton, and seem to come further down the thigh.

The biggest difference with both types compared to regular boxers is that they grip your legs tighter, which gives you the support by not letting everything fall down the leg, or get caught by the seam in the middle. They are also good for keeping your thighs warmer in the winter, if you live in a place like Michigan :-).

Oh well, they were by some trendy designer, so they are probably too expensive anyhow.

Actually, they come in several brands now -- the expensive ones you're thinking of are Calvin Klein, right? - but you can buy Hanes, or Fruit of the Loop, uh, Loom, too :-). The bike-shorts type that I wear are made by Spalding, and another company called Jake. And Jockey makes the boxer-briefs with a pouch front, which is even better.

Anyhow, I highly recommend these, for those DHs who suffer from the dreaded Leg Fallout problem :-).

I cant believe I am joining the on-going boxer conversation. Following the advice of many on the group, I have purchased a pair of Hanes boxer briefs. After wearing the boxer briefs for a couple of days, I came to the conclusion that they do not reduce heat! After all, they have the "pouch" of briefs and the additional material and length of boxers. Therefore, one is surrounded with more material and thus more heat! How can they help the heat count/motility issue? Please comment!!!

Aha, a serious post about this subject! Well, for once, I can think of a serious answer:

The problem here, IMHO, is not with the boxer-briefs, it's with the Hanes design. The Hanes boxer-briefs have the same fly-overlap fabric in the front that their briefs do, so you've actually got this double layer of fabric, right there where it needs to be cool. (Why do they make underwear with those fly things, anyway? Does anyone actually use them??)

The other problem I have with Hanes is that they are just plain tight, period. Their boxer-briefs don't feel that different than their regular briefs, and those things are definitely, umm, supportive. The phrase "tighty-whities" gives the idea :-). I threw out all my Hanes years ago. Still haven't figured out why they're such a popular brand. But then, I never figured out why everyone liked Windows better than OS/2, either... :-)

I'd suggest going to Wal-mart or Target and looking for some of the boxer-briefs that look like bike shorts, with spandex in them (I can't remember the brands, but several companies make them.) Spandex might sound like it would be tight, but the fabric is actually a lot stretchier -- plus it's thinner -- so they aren't as hot.

Also, Jockey, makes boxer-briefs with the pouch in front. Those are definitely better all the way around. And Calvin Klein's are not bad, although their price might tend to make your wallet infertile :-). The CK boxer-briefs still have the double-layer fly design (unlike the spandex or Jockey ones), but they seem to be cut bigger in the crotch overall.

Keep in mind, though; You'll never get any boxer-briefs that are cooler than regular boxers. It's always a trade-off between support and looseness. Maybe the pouch design is the best compromise of all.

The boxer briefs you spoke of are terrific. My husband likes them a lot...he refuses to wear boxers because they have no support and everything swings freely. Hanes makes these boxer briefs and they are not expensive at all. They are in a package right in the Hanes area of most stores. I think that Walmart has them and that Target might be carrying them now also. Actually probably all stores have them now. As I said they are the answer for those DH's they want support and don't want boxers. I assume they breathe enough for temp control.

Top of page

7.15 Did he often wear other tight clothing around the genitals (e.g., Levis, compression shorts for exercise)?

RAH - The logic behind avoiding these types of tight clothing is the same as the logic for avoiding tight underwear -- see Sec. 7.14 for the full discussion. (Personally, I would hate to give up my Levi's; fortunately it's in fashion right now to wear the "relaxed fit" kind :-)). - RAH

My DH wears those tight spandex running shorts and I can imagine all the little sperms he's cooking when he comes back steaming and drenched in sweat. Should I be trying to convince him to wear sweats or looser shorts? Of course, the issue of support comes in to play here, too - he claims the tights hold him "together" and it would be like me running without a bra. Any opinion?

I haven't seen any studies or other hard evidence on that question, but my guess is that wearing them for an hour or so isn't going to be as bad as wearing tight briefs all day, or going into the hot tub. FWIW, I wear the spandex bike shorts when I run too, and I don't have a male-factor problem, so they can't be TOO bad... :-)

I think several things are relevant here:

* Unless he's training for a marathon or running for hours at a time, he's probably not keeping the shorts on for any great length of time. The effect is cumulative, so this isn't the same as wearing, say, bikini briefs, or even Levi's, all day long every day.

* My experience is that the testicles don't get as hot during running as they do in a hot tub. Running generates a breeze, and all that nice sweat that your DH produces is also cooling him off; so overall everything stays cooler.

* The bike shorts are better for keeping cool than other exercise shorts, because they "breathe" and allow the air to circulate through them, whereas cotton or nylon gives you a clammy feeling, and feel hotter, to me anyway. I know I feel hotter down there (and everywhere) when I wear sweats.

* The support issue IS important -- I can testify that if I run or do anything vigorous without support, I'm not gonna feel much like doing anything fertility-related for a while afterwards :-). So, he's right -- running in sweats or looser shorts may help one problem, but creates another.

Overall, I'd suggest that he keep wearing them for running -- the exercise is good for fertility (and health in general) anyway; and if he wears anything else he's probably just going to get even hotter. It's also probably a good idea to run at night or early morning (coolest time), and to run without a shirt, to keep his core temperature down.

(I was about to add that the biggest difficulty with this advice is wearing those bike shorts without another pair of shorts over them -- it's kind of embarrassing to do that, because it makes you very, uh, conspicuous. But then I thought "Roger, you've been describing your underwear and various other intimate details of your life to 23 million people on the Internet... what's the big problem?!" :-) For DH's with a higher embarrassment factor, maybe it's another good reason to run at night :-) ).

The only thing I'd add [concerning spandex running shorts] is that he probably ought to take the shorts off right after he gets home, and maybe take a cool shower if possible -- I do that, but maybe not everyone does. Also, does he wear underwear under the shorts? It's probably better not to, but there's also the embarrassment factor to consider ;-). Maybe a good compromise is to wear a very loose pair of shorts over the spandex ones -- sometimes I wear my Umbro soccer shorts over the spandex, which doesn't seem to be much hotter than the spandex alone.

Top of page

7.16 Did he often take hot baths / hot tubs / saunas?

RAH - Avoiding hot water on the testicles is probably equal to switching underwear, as measured by frequency of advice to men. The idea of course is exactly the same -- keep them cool enough to ensure healthy sperm. Moderation is probably the key here: A short hot shower isn't going to cook your entire season's sperm supply all at once! On the other hand, soaking in a steamy hot tub for a few hours is definitely not a way to enhance male fertility.

Incidentally, the effect of hot water on women's fertility is not completely known, but there is no reason to think it poses a major fertility problem -- certainly nothing like it does for men. - RAH

My DH and I just got a hot tub--he's got recurring back pain and the job plus baby-making is getting to him. Anyway, when DH and buddies were setting it up, one fellow said, "Now, Jayne, you know you can't use it if you get pregnant!" So here I am asking you folks to clarify if possible all the questions running through my head!

1. Will water temp affect sperm? (kinda like the briefs vs boxers debate)

2. Will the hot tub affect me conceiving?

3. Is the concern only for when pregant, and if so, how early in the pregnancy would there be risks?

Re: Effects of hot tubs on male fertility and pregnancy.

1. Hot tubs will almost certainly render the man infertile. Sperm production declines when testicular temparature is above about 93 F, and they are destroyed at temparatures over about 102 F. If you bath in water over 102, kiss the sperm goodby and forget conception for the next 75-80 days (that's how long it will take to recover). It is generally recommended that men avoid hot tubs all together, as well as hot showers and tight fitting underwear and other clothing that does not allow for the testes to descend freely to maintain proper scrotal temps.

2. For pregnant women, it is advised to avoid hot baths over 100F. Period. At 102 there is potential risk to the fetus after as little as 10 minutes in the tub. That risk becomes almost a certaintly at temps over 104. There are two issues here: raising the temp of the amniotic fluid to over 102 (the time it takes for this to happen has to do with the amount of fluid, thickness of the skin and amount of insulating fat), and the effects of immersion into hot water on maternal blood pressure.

So if you're on the lean side and in the early stages of pregnancy, stay out of the tub or make certain it's not above 100. Later on, if you're well insulated, 10 minutes at 102 might be OK. Personally, I'll keep it at 100. Everyone responds differently. A couple of books recommended taking your temp before going in and then get out as soon as *your core body temp* rises more than one degree. Seems like that's a way to turn a relaxing experience into a lab experiment!

As the books we're read suggest, "dangle your feet in the spa, if you must, but keep the rest of you cool and cozy."

The same rules, guidlines and rationale applies to saunas and steam rooms as well.

All this stuff is well documented in the many pregnancy-related texts.

1. Will water temp [in the hot tub] affect sperm? (kinda like the briefs vs boxers debate)

I hate to be a downer, but the answer is "It's definitely not gonna help them." The issue is the same as briefs versus boxers -- the water in hot tubs is usually over 100 degrees F., and this is definitely too warm for sperm, which tend to start "wilting" above 92-93 degrees.

2. Will the hot tub affect me conceiving?

There's a lot less evidence for this, either plus or minus -- there's no reason to think it will affect your "plumbing" as it does his. But, keep in mind -- the whole intricate orchestrated process of rising and falling hormone levels through the monthly cycle is incredibly complex; and anything that affects one element can cause "propagation" problems (pun intended :-) ).

3. Is the concern only for when pregant, and if so, how early in the pregancy would there be risks?

I'm less certain about this -- I seem to recall reading that during pregnancy, anything over 101 degrees F., for over 10 minutes, is risky. Anybody know more about that one?

Because I am slightly *overworried* about our new toy, I have told DH that I will only go in during my period and he can only go in the week before! So much for fun ;)

I hate to be even *more* of a downer, but it takes 70-80 days for a sperm cell to reach maturity -- so he might have to stay out for longer than one week per month :-( . The critical question on this is whether or not you're dealing with male factor -- marginal sperm counts obviously require stricter guidelines than excellent counts.

Hey, here in Michigan they have something called the "Polar Bear Club" -- every year on New Year's Day, a bunch of people cut a hole in the ice on a lake, and go in swimming. Maybe you can persuade your DH to take up a new water sport :-) .

Well, DH's counts are never that great, but we have noticed a direct (inverse) correlation between his count and the number of his beloved hot baths. When he stopped taking long baths every night, his count doubled. Still way low, but a significant improvement.

I have another stupid question along these lines, related to disagreement with DH. From this thread, it seems that ANY exposure to hot tub and other high temps kills sperm and spermatazoa and it takes 2-3 months for counts to go back up. My DH thinks things are ok if you spend less than 15 minutes in the tub. We went on vacation a month ago and went in the hot tub maybe twice, I am wondering if that is a problem? Maybe we should go through the semen analysis again?

Exposure to heat kills sperm already produced and stops, at least temporarily, sperm production. The scrotum has a pretty elaborate mechanism for controlling the temp of the testes (adjusting blood flow, re-positioning the testes within the sac, etc) so how long it takes to kill off how many sperm varies.

The direct effect on fertility likewise varies. If you start out with x-number of sperm and loose 20%, if that X is very high, this may not affect fertility. If that X is low to begin with, the loss of viable sperm can put you below the threshold necessary for fertilization.

And I repeat: if you spend enough time in hot water, you'll at some point blow your fertility for those 2-3 months -- completely. And the effect is cumulative: each and every soak in the hot tub is killing off some sperm---maybe some, perhaps all. And depending upon the water temp, it may take 5 minutes, or 15 minutes, or...?

The bottom line is, if you're trying to get pregnant, forget the hot tub for a while. It's an awfully small sacrifice, guys!

It's recommended that if you use hot tubs it should be for less than 25 minutes, even if you're not trying to have a baby. Maybe that means only 10-15 minutes if you are going to use it anyway. My understanding is it can kill sperm for up to two or three months! Doesn't seem worth it to me.

My husband and I *didn't* buy a hot tub for just this reason. A friend gave his up after the RE told him too -- they'd been trying for a year. They got pregnant within six months after draining the tub.

We started trying to have a baby in July of 1994. In April of 1995, we got pregnant, but miscarried at 6.5 weeks. Kept trying, and got pregnant at the end of August. I am now 17 weeks pregnant, and hoping to stay that way:-) So, 9 months before the first pregnancy, and 3+ for the next. Nothing happened until I convinced my husband to start taking cooler baths. We live in an old house and have no shower, so he took a hot bath every morning. Once he stopped this, things started to happen. Just a coincidence??

To those of you out there with hottubs: Does regular soaking in a tub effect a man's ability to conceive if he has a normal sperm count? I know people having problems conceiving are told to avoid them. But what about people who in the past haven't had any problems? Anyone out there had luck even while using the tub?

Supposedly, it reduces the sperm count. I was all set to have my husband stay out of the hot tub for a few weeks before we started trying (after all, I've had to stay out of it for nine months!). But we decided not to wait as long, so he didn't get a chance. We got pregnant the first week. I know from a lot of other people that we were really lucky -- I would say if you have problems getting pregnant, he might try staying out, but you don't have to make him give it up right away?

I have had request to summarize the information I got when I posted the question Do baths affect fertility.

1. "Baths should have no effect on cervical [fluid]" was the response of almost everyone who responded to the question, although I did get a lot of you who suggested that with unexplained infertility you can't be too careful.

2. No, bath water will not enter the uterus. If it did, you would have severe cramping and know it.

3. The main information I got was on the temp of baths: Most of us know that hot baths kill sperm, but a lot of people that responded indicated that it can have an adverse affect on the egg, and also interfere with implantation. I got the excellent suggestion of not testing the temp of the water, but instead moniter my temp while in the tub (vis good old bbt). It was suggested that my body temp should not rise above 99.6 while in the tub.

I hope I have not left anything major out. Once again thanks to all of you who responded. We are day 11 and ready to start BMS for the month (baby making sex). It is a great feeling to know I can do something a little different this month, and have a reason why it should work this time when it never has before. I LOVE THIS GROUP.

Does this hot tub rule also apply to hot showers?

Yes. Hot water is hot water and when your in it, you get hot testicles and the sperm don't like it that way :-)

Since the temperature of the testicles can cause sperm problems, hot showers would be included if they are long enough to get the body temp up (30 minutes is pretty long). All these things seem pretty variable -- like does he actually stand directly under the water the whole time -- you know what I mean? It seems to me it would be worth a try to see if he's willing to lower the temp a little or shorten the time and see if his count improves. It may take a couple of months to make a difference.

Top of page

7.17 Does his occupation require him to sit in one position for long periods?

RAH - Although many men don't realize it, remaining seated for long periods can cause the testicles to become overheated, producing the same effects as tight clothing and hot tubs (see Sec. 7.14 for a full discussion.) Long-distance truck drivers and computer programmer-analysts are two examples of occupations that keep you confined to your chair for long periods. The solution is simple (and is good for overall health as well as fertility) -- take frequent periodic breaks to get up and walk around. - RAH

Top of page

7.18 Did he avoid excessive heat at night (e.g., sleep naked, avoid electric blankets)?

RAH - Don't forget that for 6-8 hours a day -- almost 1/3 of your adult life! -- you are in bed! As with all the other recommendations in previous sections, it's important to make sure your testicles don't overheat while you're asleep. My recommendation is to sleep with as little clothing on as you can, and to avoid electric blankets or any other artificial heat source (ordinary blankets are probably okay, and probably helpful if they keep you from curling up in a tight ball to stay warm!) See Sec. 7.14 for a discussion of the efects of heat on testicles and sperm. - RAH

We went through 5 years of trying and even though my husbands counts were normal we still went through all the steps to increase our chances - boxers, etc. - but one thing that we were unaware of until we met with the andrology lab was that heated waterbeds are bad for sperm counts. We had never thought about it but it did make sense so we got rid of ours and we did get pregnant about 4-5 months after that (we were doing metrodin/IUI cycles). I'm not sure if that had anything to do with it but I just thought I'd pass it along.

[RAH - My opinion is that heating in waterbeds shouldn't be bad for male fertility unless they are warm to the touch; but
I am no expert on how warm waterbeds should be! In any case waterbeds may have other drawbacks when it comes to conceiving -- see Sec. 10.9. - RAH]

Top of page

7.19 Did he often take lengthy bicycle rides?

RAH - One of the more obscure potential hazards to male fertility comes from the currently-popular sport of bicycling. This is partly the same problem as exercise in general -- too much heat on the testicles. But bicycling adds a couple of twists. The vibration and jolting (already greater on a bike than most other vehicles) are concentrated mainly on three pressure points: the two hands on the handlebars, and the narrow point of contact betweem the seat and the crotch. This means that the testicles are at "ground zero" for a lot of jarring. Additionally, bicycling on the narrow seats popular nowadays exerts a lot of pressure on the testicles and nearby parts of the male reproductive anatomy, such as the prostate and the delicate network of tubes connecting testes and the urethra.

Bike-riding hasn't been conclusively proven to reduce sperm counts, and if you know you have no male-factor fertility problem then there's no reason to give up the activity (which is good for all-around fitness). But if there's any doubt, parking the bike for a few months might not be a bad idea. - RAH

Top of page

7.20 Did he try "artificially" cooling his testicles? How long?

RAH - This might seem to be one of the most far-fetched fertility treatments in existence -- not to mention one of the hardest to explain to friends and family! As noted below, however, this is a recognized fertility-enhancement method -- although an icepack is probably more "cooling" than necessary.

It's important to realize, though, that this is NOT an overnight cure for heat-damaged sperm, or even a one-month cure. As noted throughout this FAQ, it takes 70-80 days to completely overcome the effects of excess heat on the testicles. - RAH

My husband is now packing the ice every night... I recall the post saying to put that blue ice in the freezer for 10 hours. Wrap it in a towel and have your husband put it in his briefs (yes, pull the briefs back out [of the drawer]) before going to sleep. The guy said he had an improvement but it did not say how much of an improvement it was. He also said it was not so bad, which my husband agrees with. I guess we'll try anything - it makes sense to me!!

Does there exist such a thing that a man could wear that would keep the testicles cool so that his sperm does not get "cooked" thus fixing some of the problems associated with overheating?

I have seen this (called "testicular cooling devices") described in the book "How to be a successful fertility patient" by Peggy Robin. Basically there are two types - one is battery operated and water needs to be added every four hours. another consists of using blue ice packs and changing them every so often. see pp 247 - 249. There isn't much conclusion about whether they work or not! but compared to everything else we try who knows? the book doesn't describe where to get one of these.

[RAH - The testicular cooling device, or one like it, is also discussed in the book _The Couples Guide To Fertility_, by Berger, Goldstein, and Fuerst. - RAH]

Top of page

7.21 Did he often eat non-organically-grown bananas?

RAH - Like the testicle-icepack, this might seem to be one of the most improbable male-factor solutions around. There's no clinical evidence to support this claim, as far as I know; on the other hand, avoiding non-organic bananas is maybe the easiest thing to do on this whole list of male-factor solutions -- why not try it? - RAH

On another subject, I remember reading on this NG that bananas could adversely affect males unless they were organic. I guess I changed my hubby over to organic bananas in October or November, so that could also be cause of his increased sperm count.

(There is some pretty clear evidence that a common agricultural chemical used in growing bananas effects sperm morphology and motility---to the point of sterilizing farm workers. The chemical is absorbed into the growing fruit, so peeling it doesn't help. Does this affect the casual banana eater? Who knows. Do ya think if the government health people knew the answer that they would tell us?)

Did he often eat non-organically-grown bananas?

Yes, regularly. [Successful conception followed.]

Top of page

[ Chapter 7 Beginning | Low-Tech FAQ TOC | FAQ List | Next Chapter ]

Ovacue #1 Fertility Monitor