5. Avoid meddlesome activity: Intrusive and unhelpful activities include strict coital timing and use of calendars and basal temperature recordings, none of which have been proven to increase the probability of pregnancy. Other meddlesome activities include limitations or interventions on diet and medications, exercise or other activities that have not been shown to increase pregnancy rates. These may cause disruption, cost and stress in the patient’s life.
Conscientious clinicians naturally try to help patients, and when medical therapy is not available they may resort to suggestions about rest, lifestyle, diet and other diversions. With respect to infertility, there is a fertile window in the six days ending on the day of ovulation (ASRM, 2014). Thus, infertility clinicians commonly recommend timing of intercourse according to the menstrual calendar or another indicator of the occurrence of ovulation, such as cervical mucus or a urinary LH test. This advice, based on observational studies, is not supported by good quality evidence.
When cohabiting women and men are having coitus two-to-three times weekly, there is no evidence from natural cycles among infertile couples that strict coital timing, more frequent intercourse, use of calendars or basal temperature recordings increase the likelihood of conception. In fact, there is good quality evidence that timing methods may not work from studies in cycles of clomiphene citrate administration or intrauterine insemination: pregnancy rates were similar with all of the methods of timing (Johnson, 2011; Smith, 1998). Also, no good-quality evidence supports the suggestion to decrease frequency of intercourse in the non-fertile period. Of course, if the woman and man seldom have intercourse, it might be helpful to suggest increasing the frequency during the fertile period.
If information on timing intercourse has no known effect on pregnancy rate, does this advice have other benefits? Advice on how to recognize the fertile period may help to involve the couple in their management; also, it may allow them to sense that they are taking some action. At the same time, a forced change in their natural pattern of intercourse may cause tension and have adverse effects in the life of the couple. Judgment is needed in each case, but in the infertility setting supportive counselling may be preferable to unproven suggestions and interventions. Clearly, it is also important to avoid unhelpful procedures, such as endometrial biopsy or dilatation and curettage.
- Advice about diet, life style and rest is usually not based on evidence.
- Advice about intercourse timing usually is not helpful or based on evidence.
- Avoid unnecessary procedures.