When trying to conceive using fertility treatments (like intrauterine insemination (IUI) or in-vitro fertilization (IVF)), the need for sex to get a positive pregnancy test is taken out of the equation. But that doesn’t necessarily mean you’ll stop having sex altogether and you might have some questions. Is having sex during fertility treatments safe or recommended? Are there benefits? What about orgasm (with or without a partner)? Here’s everything you ever wanted to know about sex during fertility treatments—and maybe some stuff you didn’t want to know.
Can you have sex while doing IVF?
First things first—it’s important to listen to your doctor when it comes to dos and don’ts because everyone’s situation is different. That said, in our experience we have found that doctors will often err on the side of a blanket no sex. So, here are a few questions you can ask your doctor to further understand what is safe for you to enjoy.
What do you mean by “sex”?
Sex means different things for different people and for different relationships. Some couples might think sex is strictly referring to penetration, but that is likely not the case for all partnerships. Others might think sex is equivalent to orgasm—which is also not true for everyone. Asking this clarifying question will help to understand why your doctor is suggesting you refrain.
Can I still orgasm?
There are some instances where orgasm might be off-limits (which would then prevent masturbation in many cases as well). This is because during a female orgasm, the hormone oxytocin is released and causes the uterus to contract. For males, they may be asked to abstain from ejaculation for a specific amount of time before producing a sperm sample (either for testing or for use in an IUI or IVF cycle).
Should condoms be used in penetrative sex?
There are certain cases where introducing semen to the female reproductive tract may not be recommended, most commonly surrounding the risk associated with bacterial infection. This includes yeast infections and bacterial vaginosis. Also, if you’ve had an endometrial biopsy taken (EMMA/ALICE test) and found out you have a detrimental or pathogenic bacteria in the uterus, there’s a chance your partner’s semen could also host these bacteria. If their semen contains a particular strain of unfriendly bacteria, having your vagina and uterus re-exposed to that bacteria could cause it to disrupt your treatment. In these cases, you can still enjoy intercourse, but you’ll need to use a condom to prevent transferring microbes to your partner.
If the recommendation is to not have sex, when does this change?
There may be specific times in your treatment where it’s recommended to refrain, but make sure to ask about these parameters. Can you have sex after retrieval? After transfer? After a positive pregnancy test? During the two-week wait (more on that, below)?
Are there benefits to having sex while undergoing IVF?
Orgasm during fertility treatment
Reducing stress and promoting relaxation is always recommended during fertility treatment (and in general), especially when compared to the alternative (stress and anxiety: not great for your health). Experiencing orgasm is associated with greater couple satisfaction, not to mention relaxation for the individual, too. Reaching orgasm provides hormonal and reproductive benefits, including the release of oxytocin which happens when you are skin-to-skin with your partner (consider this the feel-good, cuddle hormone). Oxytocin is released when you orgasm and causes the uterus to contract, creating suction so that semen and sperm (if there is any in the reproductive tract) are sucked up toward the uterus.
Semen in the uterus during fertility treatment
The presence of semen within the female reproductive tract can be beneficial for embryo implantation and development, as initially shown in animal studies. Both the cervix and the uterine lining respond to the presence of semen. In a human IVF study, having intercourse once within a four day period—from two days before to two days after embryo transfer—didn’t change pregnancy rates, but it was associated with significantly greater viability of pregnancy at six to eight weeks compared to couples who had abstained.
Analyzing data from seven different studies, there were also significant improvements shown in clinical pregnancy rates (but not ongoing pregnancy or live birth rates) when the female reproductive tract was exposed to semen after an egg retrieval or within two days before or after an embryo transfer. More recently (March, 2023), a study on intercourse during IVF found that couples who had intercourse the night before an embryo transfer had higher implantation and clinical pregnancy rates during their frozen embryo transfer cycles compared to those who abstained.
Even if you’re unable to get pregnant from intercourse alone, having sex and introducing semen to the uterus around the time of your embryo transfer may assist in your embryo’s implantation.
Can I have sex during the TTW?
You might want to consider avoiding intercourse and female orgasms during the two-week wait, or at least for seven days post-transfer. Since the uterus contracts with orgasm, there has been some concern that these contractions could affect the embryo as its implanting. One study found that having sex one day during the implantation window increased the odds of miscarriage compared to those who abstained. The risk of miscarriage was greater in those who had sex on two or more days in the week post-transfer. Taking into account what we know about the benefits of sex and semen within the transfer window as described above, intercourse may be safest if enjoyed within the two days before transfer (instead of after).
To stay on the safe side, avoid intercourse and female orgasms (orgasm equals uterine contraction, whether it’s with a partner or solo) for at least a week post-transfer. If you have a positive pregnancy test and you have the green light from your doctor, you can safely resume your sexual activities.