TIMING OF SEXUAL INTERCOURSE IN RELATION TO OVULATION Effects on the Probability of Conception, Survival of the Pregnancy, and Sex of the Baby

Background. The timing of sexual intercourse in relation to ovulation strongly influences the chance of conception, although the actual number of fertile days in a woman’s menstrual cycle is uncertain. The timing of intercourse may also be associated with the sex of the baby. Methods. We recruited 221 healthy women who were planning to become pregnant. At the same time the women stopped using birth-control methods, they began collecting daily urine specimens and keeping daily records of whether they had sexual intercourse. We measured estrogen and progesterone metabolites in urine to estimate the day of ovulation. Results. In a total of 625 menstrual cycles for which the dates of ovulation could be estimated, 192 pregnancies were initiated, as indicated by increases in the urinary concentration of human chorionic gonadotropin around the expected time of implantation. Two thirds (n 129) ended in live births. Conception occurred only when intercourse took place during a six-day period that ended on the estimated day of ovulation. The probability of conception ranged from 0.10 when intercourse occurred five days before ovulation to 0.33 when it occurred on the day of ovulation itself. There was no evident relation between the age of sperm and the viability of the conceptus, although only 6 percent of the pregnancies could be firmly attributed to sperm that were three or more days old. Cycles producing male and female babies had similar patterns of intercourse in relation to ovulation. Conclusions. Among healthy women trying to conceive, nearly all pregnancies can be attributed to intercourse during a six-day period ending on the day of ovulation. For practical purposes, the timing of sexual intercourse in relation to ovulation has no influence on the sex of the baby. (N Engl J Med 1995;333:1517-21.) From the Epidemiology Branch (A.J.W., D.D.B.) and the Statistics and Biomathematics Branch (C.R.W.), National Institute of Environmental Health Sciences, Research Triangle Park, N.C. Address reprint requests to Dr. Wilcox at the Epidemiology Branch, NIEHS, Research Triangle Park, NC 27709. C ONCEPTION can occur only near the time of ovulation. However, the number of fertile days before or after ovulation is uncertain. Estimates range from 2 days per menstrual cycle 1,2 to 10 days or more. 3,4 Other issues related to fertility also remain unsettled. For example, what is the frequency of sexual intercourse that will maximize a couple’s chance of achieving a pregnancy? If intercourse is poorly timed or infrequent, will sperm that have aged in the female reproductive tract before ovulation produce a less viable conceptus? Can a couple influence the sex of their baby by timing their intercourse in relation to ovulation? We addressed these questions in a prospective study of healthy women who were trying to conceive.