Make Sure You Know the Right Time for Spicy Time During Your Fertility & Pregnancy Journey

Dr. Amber Klimczak and Dr. Beverly Reed discuss how Brittany Spears describes spicy time during pregnancy as the best ever. They discuss the perfect time to have intercourse while trying to conceive. They discuss their thoughts on when you should and shouldn't have intercourse during the fertility treatment journey as well as the reasons why. They also discuss intercourse during pregnancy and reasons why someone should hold off.

Transcript

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Hi, I am Dr. Beverly Reed. And I'm Dr. Amber k Clack. And we are two peaks. Two peaks in a pod. Pod. Well, hi everybody. Welcome back. We have a bit of a spicy topic today, right? Yeah. Spicy for us. I'll say this was Dr. Kay's idea for a spicy topic. Um, okay, well let's kind of talk about a celebrity here. So we're gonna talk about Britney Spears, but we'll say. This topic was actually triggered by our patients. Mm-hmm. Because one of the most common questions we get is, when should I be having intercourse and when should I not be having intercourse? Mm-hmm. And so, um, I was gonna bring up Brittany Spears, who a couple years ago in an interview, she actually said that when you're pregnant. It is the best sex ever. She said, it's just so great when you're pregnant. And I wanna comments on this, do true a highly debatable opinion. I mean, of all. There's so many different times in pregnancy. Does she mean the beginning of pregnancy? Yeah, the end of pregnancy. When is she enjoying it so much. I know, but like I feel like pregnancy is really rough in the beginning, the middle and end. I'm like, yeah. When are you enjoying this? When you're super sick and nauseous or when you're big as the house? Like when, when are you enjoying this? Britney Spears? I dunno. Yeah. I mean, if you work so hard to get the pregnancies, sometimes you're like. Don't touch me. That's right. Like, you're gonna mess it up, you know? Exactly. So. Exactly. Yeah. Yeah. So, um, so I'm very intrigued by what she had to, uh, say, and full disclosure, I did look up some other celebrities who I feel like made some more realistic comments. Chloe Kardashian said, look, I mean, it might be great, but also uncomfortable, especially as you get bigger and further along and everything. And then Kim Kardashian had even commented that. During her fertility treatment course, it really can affect and, um, you know, make it not as fun when you're mm-hmm. Um, involving so many other things. Stress, um, from fertility treatment and, and all of that. So I think it's just variable. Right? Yeah. Everybody's a little different. Yeah. Yeah. Um, okay. But, um, I wanted to start off by telling you my story. We have to be careful when we post our clips from this, you know how we usually post on social media. Mm-hmm. Well, when I was a new via Instagram, I had posted something and I didn't really know about how hashtags can, and, you know, really interfere with things. And so I had hashtag my posts. Hashtag sperm. You should not hashtag yourself with sperm on Instagram is what I found out. I accidentally put myself on porn threads. Oh my God, I should know. Hashtag intercourse. So as we post this on Instagram, we're gonna have to figure out how we're gonna. How we're gonna hashtag this. Yeah. So let's just be careful with that. No. Hashtag sex. No hashtag intercourse. Exactly, exactly right. Yeah. No, but in all seriousness, um, I think if you're a listener at any point in your fertility journey, I think it is a very common question. Yeah. For you to just say, when can I have sex? Right? If you are trying to get pregnant and you're just trying on your own, you're probably Googling, when am I supposed to have sex? When am I not supposed to have sex? During your treatments, um, after your treatment, once you're pregnant, I feel like there's. So much mis mm-hmm. Misinformation out there. Um, and this is one of the questions that I feel like the partners really wanna know the answers to. Oh hundred percent. Yeah. Usually it's not the patient, it's their partner that is asking. Yes. Yeah. Well, I'll say at the new patient visit, these are kind of common things that get brought up. Um, so first, the biggest debate is. Every day during your fertile period or every other day. Right. People are very adamant about this too. Where, what do you, what's, what's your side? I say every other day. Okay. Leading up to ovulation? Yeah. Okay. Ovulation because. I just don't want you to wear yourself out. I know. It's a lot. It's a lot. Especially if you're gonna be trying for, you know, a while. Yeah. Um, I think every day. And sometimes people, you know, are really not sure about the window. Yeah. So then the every day turns into every day for like a week and a half. Yeah. And I'm like, listen, like. Some of us have to go to work. Yes. Okay. I feel like I kind of lean towards every day. But you're right. I will say it is true. It's exhausting. So if I tell somebody every day and I can see the look on their face, like, are you serious? Like, who has time for that? Then I'm always like, well, every other day is fine too. Yeah. But it's kind of, you know. Either way. I don't get too worked up about it. The biggest concern I hear when I say every day is they say, well, if we do it every day, are the sperm counts going to be lower? And okay, it is true if you ha if a man had just ejaculated the day before, then the next day his sperm counts may be lower. Also over two ejaculations, you probably got more sperm than you would've had just from one. And so I say don't, don't worry. Like I feel like sometimes they're getting so into these details. But if it's like either every day, every other day, if you're not getting pregnant, there's probably something else wrong. That is not the issue. That's probably not the reason. It's not the issue about whether you're doing it every day or every other day. Right. And how. How precise you can be with nailing down your window. Yes. You know? Mm-hmm. I think every day is, is more feasible when you're fairly certain. Some people know exactly when they're gonna ovulate. Yes. You know, so yeah. If you're one of those people, I think it's reasonable. If you're like, yeah, I'm not really sure. Okay. Around, mm-hmm. You know, the cycle days, we've talked about this before, after you stop bleeding from your period. Right. You're, that's that time period where you're gonna be ovulating the next. Week or so. So every other day leading up to that mid cycle point is plenty. Yeah. Yeah. And then another point that the partner will often bring up is sometimes, you know, when a patient comes to see you, it's almost like they feel a little unsure as if they actually are considered to have infertility. So you know how we'll say, well, how long have you been trying? And so many times they'll say. Well, we weren't really trying, but like in the last couple of months we've been trying. Mm-hmm. And I say, well, when you say you weren't really trying, what kind of birth control were you using? Oh, I wasn't using birth control. Were you sexually active? Yes. Okay. To us, that's trying, you know, right. You're either protecting or you're not. Right. Um, but, but what the guy will often say is, well, I think we weren't having sex enough and, and so, you know, they wanna hear from me. Yes. You need to be doing it more, more, more. Yeah. But you and I know you can only get pregnant during a narrow window every month. Right. So I don't necessarily back them up on that. Yes, very true. May be like, Hey, we're only trying a couple days a month. Yeah. But if fertile. I mean, really, that's kind of all you need to be. Yeah. And our type A patients, I mean they, you know, they lock it down to those days sometimes. I mean, I understand. So that's why Yeah. But that's another question that I have gotten even with patients trying on their own. Yeah. Um, I think there's kind of some strange things you can Google out there. Mm-hmm. Mm-hmm. Um, but let's say you're trying to get pregnant and you are trying during your fertile window, but then after ovulation, you're in that second part of your menstrual cycle. Yes. I have patients ask me a lot, well, if we have intercourse after ovulation, am I gonna mess up the pregnancy? Mm-hmm. Am I gonna disrupt implantation from occurring? Mm-hmm. Mm-hmm. Um, and I think that if you go out there and Google it, you can find some blogs that say that. Really? Okay. We don't have any data to support that. Yeah. You know, pregnancy af or the intercourse after, um, ovulation is gonna affect early pregnancy. Mm-hmm. Or implantation or anything like that. Mm-hmm. Well, maybe a good thing to bring up with them too is some of the research that is going on for when we do a frozen embryo transfer. Yes. Mm-hmm. Um, and we'll put talk about this a little bit later too, but there is a big debate on whether you should have intercourse before a frozen embryo transfer. But from an immunology perspective, you know, I love immunology. They do say sometimes it's good for the immune system to be exposed to a lot of that foreign DNA through the sperm that potentially a pregnancy could bring that exposure to. So, um, but I mean, I think it's a good question, but I, I don't really think it hurts anything. What do you think? No, I don't think, I don't think it hurts anything. But like, I mean, I definitely understand too, if you've been having intercourse every day. Yes. You know? Well, that's right. You might be like, Hey fertility doctor, do we have to take a break for 10 days? Dr. Re said before intercourse for a while. Yeah. Yeah. Well, another good question I get to is, you know, I love progesterone Prometrium. Mm-hmm. So I give a lot of my patients Prometrium Now, um, progesterone is usually best absorbed vaginally or through shots for, um, IUI or intercourse cycles when I'm giving Prometrium. It's just a vaginal capsule that you put in every night. And so people worry, can I have intercourse if I'm using this? And we definitely say yes, but here's the thing. I say, look. Usually I have you put the Prometrium in vaginally right before you're about to go to sleep. So I'd probably have intercourse first. Then pop your Prometrium in, right? Mm-hmm. Yeah. Yeah, yeah. And it, you know, it can be a little messy. Yeah, exactly. Um, okay, so let's say somebody is. Starting more intensive treatment with us. You know, they've seen us with a new patient visit and now they're doing fertility pills, um, with us. And, um, let's say they're gonna be doing an insemination with us. Do you have any special advice for whether they should have intercourse at certain times? Um, around this IUI cycle. Yes, definitely. Yeah. So, um, I guide my patients. I always tell them, Hey, I'm gonna take all the romance out of it. So, um, and I think they actually appreciate that sometimes'cause it's been such guesswork mm-hmm. Um, at the beginning of the cycle. Right. You can do whatever you want, but, um, so like when you're taking the oral medication, I say that's just for fun and if you wanna have intercourse for fun, that's fine. Right? Yeah. By the time they come back to see me for their follow up ultrasound and we're trying to see how you really. Responded to the medication. That's the first point where I'll say, based off of their cycle and the response that I'm seeing, I'll give them some guidance on how I want them to time intercourse. Typically what I'll do is I'll time at least one, you know, episode or you know, whatever of intercourse, and then I'll also tell them at what point I want them to. Stain so that we have a nice specimen for the IUI. Mm-hmm. It usually works out that way. Sometimes we're like, Ooh, you've had a really quick response. Yeah. And it's time for the I ui, you know, even that day or the next day. Yeah. So then we don't even have intercourse and um, we'll tell them just to kinda supplement with intercourse after the IUI. Mm-hmm. But I think that's the first time that I usually give them regulations. Yeah, yeah. Yeah. I would say this would say be almost like a common mistake. State that I feel like I see sometimes is somebody knows I'm gonna do an I UI cycle, right? So then she's telling her partner, or maybe her partner does it on his own. Hey. Save up all that sperm, right? Mm-hmm. And sometimes by the time we're about to do the IUI, they say, great. He's been saving it up for a month. Gosh. And I'm like, gosh, oh no. Oh my God. You know? Because the one, it's just not necessary, but number two, because sometimes when sperms been sitting in there too long, it looks a little old. Mm-hmm. It's not really what we consider to be the freshest sperm and everything, so. I would say, gosh, don't feel like you have to hold back or anything. Just kind of do what you wanna do and then as we get closer, we'll definitely give you instructions. I think it's hard because at the beginning of the cycle, people always are kind of asking me like, what am I gonna need to do? But I'm like, you really do have to wait for that monitoring sonogram, right? Mm-hmm. The instructions are gonna be different from patient to patient on what to do. Um, I would say probably the most common one is when they come in, their follicles are almost ready. I try to time it. Mm-hmm. So it's like almost ready. And so usually what I'll say is go ahead and have intercourse today, then abstain the next day. And then the day after that we'll do the insemination. That's probably the most common, um, that I will see. But a lot of times patients worry about that too. They say, well, gosh. When you told me he needed to do a semen analysis, you told me he had to abstain for two to five days. So with this plan you're giving me, he's not abstaining for two to five days. And I'm like, that's true. But that is when you're doing a semen analysis, when you're doing an IUI, we're really trying to make, um, really any opportune moments maximized here. And I know before. Before you ovulate. That's a great time to put some sperm in there too. Sperm can live in the body for up to five days, so why miss out on that opportunity? However, if I have a patient that comes in and their follicles are ready to go, I agree. We just say, look, no intercourse today, we're gonna be doing this tomorrow. Right? Right. Exactly. Yeah. Every once in a while too, I get into the situation where we might be trying a new dose. For a patient where I'm not really sure how they're gonna respond to their dose of medication. And so I may give my patients a heads up even leading up to that first ultrasound to check for response. I don't want you having intercourse. Yeah, yeah. Um, because, like Dr. Reed mentioned is sperm can actually live in the vagina for a while, and if we don't know how you're gonna respond and you release. Too many eggs, then we've gotten ourselves in a little bit of a predicament. Yes. So if I'm worried about an over response, then sometimes I warn them, Hey, no intercourse, you know, after a certain point. Mm-hmm. So that we can, you know, kind of control it more. Yes, yes. Um, okay. What do you think about intercourse the day of an I ui? How do you feel about this? After it? Yes. Well, actually, let me say before and after. What do you think? So definitely before the man collect. Right. I want them to abstain. Mm-hmm. After the IUI, I say, yeah, I say it's just a supplement. Sometimes guys get, you know, worked up or, you know, both parties can get worked up about making it happen. So I'm like, it's not the end of the world if you can't. Right. I'm like. Supplement with intercourse if you can, either tonight or the next morning is what I usually say. Yeah, absolutely. Okay. And then I know you said, okay, maybe that day and the next morning, what about the day after that? Do you think there's any benefit or do you say No, we're we're done at that point, the window's closed. What depends on the IUI timing. You know, we time, I UIs. Slightly different. Mm-hmm. But you know, most of the time that egg is gonna be released about 36 hours after we've timed your trigger or depending on what your blood work looks like. Yeah. So, and there's been nice studies to show that the day after you ovulate mm-hmm. Pregnancy is really not gonna occur. Mm-hmm. So for after that, again, just for fun. Yeah. Yeah. Yep, yep. Um, and I think I'm pretty similar. Usually I'll say, um, that, you know, the day of the IUI if they want in up to three days after. But I do emphasize the most important days are around that. Um, IUI time, I kind of give the other ones just in case somebody's like a late ovulators or anything. But even if they were late Ovulators, it would be fine.'cause remember sperm can live in the uterus for up to five days. Mm-hmm. And so I, you know, you would be good either way. So I think that's fine. Um, okay, so let's say you did an amazing IUI like you often do, and they're pregnant. Um, then that brings a whole new round of intercourse questions, right? Mm-hmm. But before we get to that part, let's talk about some of the other, um, fertility treatments. So let's say we had been trying IUI, it, it wasn't working. We're moving onto IVF and so I really want to get some feedback on how you feel about whether intercourse is okay during the preparation period for IVF and then during IVF. What do you think about that? Yeah, so sometimes as we're getting ready for IVF, we might be getting all of our ducks in row, getting your medications ordered, getting your insurance to give us special permission. Highly encourage intercourse during that time because I have had a lot of patients get pregnant. The month before starting IVF, which isn't that crazy, crazy love. Yeah. Like, you know, I always tell my patients, we do not care how you get pregnant. We're gonna be happy no matter what. Yes. We still try to take credit, right? Yeah. Yeah. So we still count that as our pregnancies. So in that month, you know, I don't really mind. Yeah. Um, it depends also kind of how you're leading into your IVF cycle. Mm-hmm. But then, as we've talked about before, with modern IVF, it's usually broken down into two parts. The first part of IVF is that stimulation part. That's the first point. Point that I'm gonna start giving my patients restrictions that I don't want them having intercourse. Yeah, yeah. Yeah. I mean, I agree. During the preparation in month, I'm totally fine. There are some types of preparations where my patient won't ovulate anyway. Mm-hmm. So it just doesn't even matter at all. Yeah. I have other preparations where I do need them to ovulate and pregnancy would be possible. So if they were open to a surprise pregnancy, then go for it. Now some of my patients, once they've made that decision to move on to IVF, I have had some that got pregnant and they were disappointed'cause they're like, Ugh, I was already for I vf, you know? And there's some other benefits to IVF too, right? Like being able to say. Embryos for the future and, and all of that. So of course, if for some reason a surprise pregnancy would not be what you want, then yeah, you've gotta either abstain or use contraception, you know, condoms or something like that. But. Um, then whenever they're starting injections, I'm actually usually okay with intercourse for the first three days of injections. If it's just kind of like a normal IVF cycle. Because at that point the ovaries are very small. They're the size of golf balls, you know, the, the eggs are just very early on, and if I think, gosh, even if they had intercourse in the sperm stays in there for five days. I think that's. Pretty safe. But certainly after about three days, I'm like, you know, I really wouldn't try to have intercourse beyond that point. The ovaries start to get really swollen and remember, ovaries are mobile, right? So if you're having intercourse, imagine the ovaries getting all knocked around and everything. I don't think that would feel good. So it's not, it's, yeah, I'm kind of surprised anybody would want to anyways, but I think it's probably not a good idea. And then the more concerning thing that would terrify us is. As you get further along, if you have intercourse and those sperm are in there for quite some time, and then let's say you accidentally ovulated before your IIVF, or let's say after your egg retrieval, there were some eggs that were left behind. You could end up as an optimum mom, right? Yes. Yeah. Yes. Yeah. Yeah. I think you're very nice to let them have intercourse for the first three days you say. No, none at all. I just feel like, you know, you can't, I dunno, it just, it can be tricky, you know? Well, what Sometimes people go early to retrieval. Yeah. I don't know. It's just, yeah. Well, what's interesting to me is I have a subset of patients that when they're on these stimulation injections, they are really in the mood and they're, they're like, I dunno what's happening to me. I'm not usually like this, but like, please. You know, so I maybe don't wanna discourage that, but, um, so, and I find that interesting because, you know how. So many women have low libido, and of course everybody's trying to figure out how to solve this problem. And I'm like, I, I know how to treat it, IF injection. Um, so I think that is, um, certainly kind of an interesting. Observation that I've seen. Have you ever seen that with patients? They tell you. I'm surprised. My patients tell me all this too. My patients are very open. I think I, I've gotta ask, um, now I can't remember. I think one of our egg freezers maybe. Yeah, yeah, yeah, yeah. They're like, this is great. I feel great. So you don't wanna discourage it, but maybe it's also a time to kind of inter, because one of my egg freezers had asked about this too. You know, look, if you have a high sex drive, maybe you can't have intercourse, but maybe there's other ways of mm-hmm. Sure. Being able to satisfy that should, that should be fine. Yeah, that's fine. Won't cause us any issues or problems, so don't worry. Um, okay, so then, so let's say we do our egg retrieval. They go home, can they have intercourse? No. Okay. Dr. K, you're so mean. I know. Okay, so why not? Yeah, I mean there's a couple of reasons now at this point. One, I mean, you obviously might have ovulated, especially like right then in that window. Yeah. Definitely don't wanna have intercourse. Also, we've just poked you with a needle. We've poked the ovaries with a needle, you know, can lead to some bleeding. We just want everything to sit. Still Right. And clot and heal. Yeah. Um, and so I usually say no intercourse, um, until you get your first period after your egg retrieval. Yeah, I agree. And if you think about it, when we put a needle into the body that is creating an opening, that might increase your risk for having an infection or something like that. So. I agree, it's the safest thing to do. It's the most comfortable, comfortable thing to do. Most women who have a robust response, you know, you kind of lead waddling out. You know, like that's just not the mood you wanna be in. Mm-hmm. Um, and so I agree, I say the same, wait until you've had your first period and then your body should be mostly back to normal at that point. So. So then usually the next part, if you had a good response to your IVF is moving onto your frozen embryo transfer. And so what are your tips for this? Do you allow intercourse during the frozen embryo transfer part? Yeah, this one really depends. Um, I would say I kind of break up my cycles into two different types of cycles. Mm-hmm. The first one being a traditional kind of program cycle where we give you the estrogen and progesterone, um, leading up to those, I think it's fine to have intercourse. There's not a lot of risk to it. Mm-hmm. Um, if we're doing what's considered a natural cycle or a modified natural cycle, you will. Actually ovulate. And I definitely don't recommend having intercourse, although you might be like, well hey, what's the problem if I get pregnant? Right. Yeah. Um, but it can lead to a lot of confusion, um, disruption down the road for you to spontaneously or get pregnant on your own during an embryo transfer. So if I'm doing a cycle where you're gonna ovulate, I say no intercourse. Yes, absolutely. And I think that's a really good point because. Most of our patients are doing genetic testing these days, right? And so there are these kind of isolated published case reports where a patient had an embryo transfer and they put in, you know, let's say it's a genetically normal boy, and then she conceives and it's a girl, and how could that happen? You know? And then they look back and they say, well, actually, with the type of cycle you did. You probably ovulated an egg from your ovary and got pregnant with your own egg rather than with the frozen, um, embryo. Like mm-hmm. Like they would've thought. So, um, I think in those cases you definitely want to avoid intercourse so that there won't be any confusion about what, which embryo you're getting pregnant with or anything like that. And then another special situation is patients that use gestational carriers if you're using a surrogate, right? Mm-hmm. Yeah. Um, so, you know, these days be, it's nice that there's so many different sort of protocols or recipes that you can use for a frozen embryo transfer, but it is really important when you're using a surrogate or gestational carrier that you not do a natural cycle. You don't want the gestational carrier to have even any possibility of ovulation because she needs to get pregnant with your frozen embryo, not with her own baby. That could be really heartbreaking. Yes. That could be a huge issue or a problem. Yeah. So those cycles are treated a little bit differently. Yeah. Um, you reminded me before that I did have an interesting case where this happened. I think, I think I told you about this. So this was this past year actually. We did an embryo transfer as a single embryo transfer transfer, just one embryo. Um, and my patient gets pregnant with twins and I was like, oh, okay. Well, you know, there's always a 1% chance that the embryo splits. Yeah. Um, and so we were looking back and she did a natural cycle. Yeah. And she, her window for where she had intercourse just did not even line up with ovulation. Wow. Like, I'm like, okay, well this must have split. Yeah. All she messaged us down the road, she's like, they're boy and girl. Interesting. Yeah. It's always so fascinating to me when that happens, right? Mm-hmm. Sometimes medically it doesn't make sense, and then a miracle happens. That's amazing. Yeah. So this patient got pregnant with her embryo and pregnant with her own baby spontaneously, which is really wild. That is really cool. And I guess because the gender, you guys know which one is which, right? So I wonder if they'll tell their kids one day like You were the one we paid a lot of money for. You were my free baby. Yeah. The funniest part about this patient is that she begged me to do. A double embryo transfer. Did she wanted to. Embryos transferred so, so badly. And I was, I was like, no, you're good. We're gonna get you pregnant. You don't need a double bryo transfer. Yes. And it was like, God willing, like she was gonna haves like Well I think it's a good point too, as to sometimes people think we don't wanna put two in because we're afraid of twins. Oftentimes we don't wanna put two in'cause we're afraid of triplet. Yes.'cause we know that they can split or you can get pregnant with your own ovulated egg and everything too. So, um, but yeah. That's amazing. Love that. Um, okay, so kind of back to what I was bringing up earlier though is there's, I saw a study that said if you have intercourse before you do your frozen embryo transfer, you may actually have higher chances of it working for you. And this is interesting because there is some debate about this. Some women when they have intercourse, feel crampy. Mm-hmm. Right afterwards, right. Why do you feel crampy? The uterus is a muscle and that muscle squeezes and relaxes, and it doesn't sound like that would be a good environment for an embryo if it's, you know, squeezing and everything. So I know sometimes people feel worried and say you shouldn't have intercourse, and other people are saying maybe it is beneficial. Again, maybe your immune system is getting more ex exposed to the sperm, but I don't know. What do you think? Is it the day of the transfer? No, before. Like the day before. Before, yeah. Or yeah, too. One or two. I just think you're so stressed the day of your transfer that like, I would just really stress me out too if my doctor's orders were like intercourse before you come. Yeah, yeah. Yeah. I, I kind of feel the same way. I'm kind of more leaning against it, but I'm like. Keeping an open mind to any of the studies they hear. Mm-hmm. And if somebody really wanted to, I don't think I would restrict them from it. Um, but also it's a good point to bring up our same sex couples and our, um, single moms by choice too, because I've had some of them say, gosh, I'm hearing this study that intercourse is gonna help. So like, you know, I don't have a male partner. Does that mean I'm gonna have lower chances of getting pregnant? And. Seeing that. So I don't think that should be a point of stress or anything like that. I wouldn't want people to worry about that. Right. And they tend to be our better prognosis patients anyways. That's true. Yeah. They tend to do better. Absolutely. Yes. Um, okay, so we do the transfer then after the transfer. What do you think? I know this is the part where like, if any of my patients are listening, they're be like, Dr. K cannot make a mind about this.'cause like, I feel like I give a thousand different answers after the transfer. Um, so definitely the day of, I tell my patients, just go home. Yeah. Chill please. Like, don't do anything vigorous. Yeah. You know, regardless. Um, you know, what did the studies show really? And like, what do we know about this? It probably doesn't matter Yeah. For you to have intercourse after Yeah. Um, a transfer. Mm-hmm. However, sometimes we've been working so hard, right? To get you pregnant and maybe we've already had a failed transfer and we just feel like we're trying to control everything. I'm like, can you just like leave this little embryo alone for like, just until we get your pregnancy test, just don't touch it. Like, you know. So I will sometimes say just like, wait to. It honestly depends, which is not a good answer from a doctor, but, but I mean, I'm the same, so I say no, and I'm super strict, probably overly strict. Mm-hmm. Now, I'll say if I compare myself to the really old school doctors. Mm-hmm. Like probably the doctors that are like in their seventies, they used to put you on bedrest for like a week after or so. We're not like that. No, no, no. Like you can go back to work the next day and everything. But I personally don't like you to have intercourse and I don't like you to do any strenuous exercise. I just say be more of a couch potato for once in your life. It'll be okay. Yeah. Um, and so then I say, let's just wait for the pregnancy test and see what happens. Um, but now back to. Yes. So know it. Yeah. Is intercourse okay? Yeah. So usually if my patients are pregnant, I tell'em they can have intercourse. Mm-hmm. As long as everything's going to plan. Mm-hmm. You're not having any complications, there's really not a risk to having intercourse during early pregnancy. Yes. Yes. I feel like for me, sometimes I do give conflicting answers. Um, part of it may depend on their history and everything too. Mm-hmm. You know, if I've got somebody who's 25 years old and she's got five embryos frozen and everything's been going great, she's never had a miscarriage or anything like that, then I'm, I'm feeling a little bit better about it. I'm like, okay, yeah. Where is that patient? I don't that, let's say it's my. 43-year-old patient who only has one embryo. This is her only shot at this. Mm-hmm. She's had a miscarriage before. I mean, I'm kind of like, no, please, no. Yeah. Let nobody touch her. Yeah. Wrap her in bubble wax. Stick a stick stick in her closet for nine months. Leave this woman alone. Like, you know. So I do feel like it just depends. Now that is not based on science at all. It's just like my gut feeling. Mm-hmm. Could second that. Yeah. Um, okay, so let's say back to that 25-year-old patient that we almost never have. Um, so let's say she has intercourse and then she calls you and says, Dr. K, I'm bleeding now after intercourse. Yeah. Hey, what do you do? So this is actually really common. Yes. Okay. Um, and can really freak you out. Yes. If you've just gone through an embryo transfer, any type of fertility treatment or not, right? Yeah. Um, so the first thing to know is it's common. It doesn't necessarily mean it's normal, which those are two different things. Yeah. But you should feel reassured to know that about 50% of women will have. Some sort of bleeding their first trimester after intercourse. A lot of times it's actually just from something bumping up against your cervix, which can, which can get really vascular, right? Meaning it has more blood flow to it. So you might have a little vessel there that's bleeding on your cervix and isn't even necessarily the pregnancy itself bleeding. That's what we typically see. I always say there's not really any intervention that we can do to stop it or make it better or prevent it from being something worse, which is really a tough situation to be in. Mm-hmm. Right. So, okay. When they come in, let's say you do every, you know, you do all the monitoring and you're like, Hey, fortunately everything is great. Baby's looking good, and they say. Well, can I keep having intercourse? Yeah. What do you think about that? If they're So, I usually make them wait. Mm-hmm. Right. Until the bleeding clears up. Yeah. Because if it is a vessel, I say, look, you're probably not gonna harm the pregnancy. Mm-hmm. Even if you did have intercourse. But if you bump it again, you might have more bleeding and you're gonna freak yourself out again. Yeah. So let's give it some time to heal. Mm-hmm. Let's see how the bleeding goes. And most of the time everything's fine. Yeah. You know, it stops bleeding and then they can go on down the road. Yeah. Yeah. Yep. Yeah. Well, I think we're really similar. I kind of do all those same things. Um, I do feel like maybe over time I may change it a little bit. I'm kind of noticing that, um, common time for bleeding to occur seems to be after the first ultrasound, but before this. Second, like between, you know mm-hmm. Five, six weeks or so. So I kind of feel like maybe I might start being a little bit more strict during that time period. I'll have to think about it. But, but we do, you know, for the partners too, we're not trying to be restrictive. We are trying to, you know, I, we know it can be stressful. It's been such a long journey at that point. Um, but, but also just trying to use our best judgment. I'll say studies do, there's not a single study. That shows intercourse can cause a miscarriage, not a single one. I think it just so happens, like you said, sometimes it can just irritate the cervix a little bit and cause some bleeding. We still wanna hear from our patients if that happens, so we can assess you and give you reassurance and make sure that nothing else needs to be adjusted. And yes, I would also probably put somebody on pelvic rest in that situation until the bleeding had resolved and she had gotten further along. Um, but I'll period, I'm. Careful about too, is when they graduate from us, because there's usually this little short window where they've graduated from us but they haven't yet seen their ov And I do kind of worry about that time period too, because if something were to happen, it's like, what? They have to go to the er, like, you know, it's a, it's a bit of a tricky situation, so. Sometimes they'll even say, well just wait till you see your OB and ask them. That's a great plan. Very strategic. Um, and then OBGYNs are all different too, so they may have, um, different advice going throughout pregnancy as well. Mm-hmm. Um, and then finally, let's say somebody's delivered their baby. And they are already calling and saying, Dr. K, you made the cutest baby. I can't wait to come back and do more fertility treatment with you. Um, I don't know. Can I have intercourse? Dr. K, what would you tell them about the postpartum? I know this is like, so this is so funny because I feel like this. Varies based off of woman. Yeah. In terms of like, whether, like some people are like, don't touch me with a 10 foot pole. Yes. You know, after having a baby. Yeah. Um, and so, but most of the time your ob g Y's going to give you instructions to wait at least six weeks Right. Until everything's healed before you have intercourse, which can be really long if you were one of those women that you know is ready for it. Yeah. So, um, our other women are like, I'm barely putting my life together. So yes. Exactly. Yeah. And a lot of times at your six week, um, period of time, that's when your ob GY is seeing you back so that they can examine the vaginal area, make sure it's healed up appropriately. And that way you can just kind of get an expert's eyes to know that it is okay. And usually that's their opportunity to talk to about contraception. It's funny'cause my fertility patients will always kind of cut off the OB GYN when they say, what would you like to use for birth control? And they say, uh, I'm infertile. I had have, I don't need contraception. Yes, you do need contraception. We both have seen many cases where the first one was very difficult to conceive, and then the second one was a surprise. Sometimes when you're, you've delivered vaginally, your cervix is more open, your body kind of has a better idea what to do. So unless you wanted a better quick surprise, baby Irish twins. Yeah, yeah, exactly. Yes. Yeah, yeah. Yeah. Okay, good. Well, I feel like we covered this pretty comprehensively. What do you think? Yeah, did we miss anything? Yeah, no, great topic. Okay, good. Alright, well thank you guys. Everybody, if you would be so kind to leave us a review on our peak fertility website, our YouTube, our podcast, um, channels, we would so appreciate it and we'll see you next time. Bye