Timed intercourse for couples trying to conceive

• Published in: Cochrane database of systematic reviews 2023-09, Vol.9 (9), p.CD011345
• Main Authors: Gibbons, Tatjana, Reavey, Jane, Georgiou, Ektoras X, Becker, Christian M
• Format: Article
• Language: English
• Subjects: Anxiety; Anxiety Disorders; Drug-Related Side Effects and Adverse Reactions; EVALUATION OF SUBFERTILITY TREATMENTS RELATING TO THE FEMALE PARTNER; Female; Humans; Male; Odds Ratio; Pregnancy; Pregnancy, Multiple; Reproductive & sexual health; Uncertainty
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD011345.pub3

Many factors influence fertility, one being the timing of intercourse. The 'fertile window' describes a stage in the cycle when conception can occur and is approximately five days before to several hours after ovulation. 'Timed intercourse' is the practice of prospectively identifying ovulation and, thus, the fertile window to increase the likelihood of conception. Methods of predicting ovulation include urinary hormone measurement (luteinising hormone (LH) and oestrogen), fertility awareness-based methods (FABM) (including tracking basal body temperatures, cervical mucus monitoring, calendar charting/tracking apps), and ultrasonography. However, there are potentially negative aspects associated with ovulation prediction, including stress, time consumption, and cost implications of purchasing ovulation kits and app subscriptions. This review considered the evidence from randomised controlled trials (RCTs) evaluating the use of timed intercourse (using ovulation prediction) on pregnancy outcomes. To evaluate the benefits and risks of ovulation prediction methods for timing intercourse on conception in couples trying to conceive. We searched the Cochrane Gynaecology and Fertility (CGF) Group Specialised Register, CENTRAL, MEDLINE, and Embase in January 2023. We also checked the reference lists of relevant studies and searched trial registries for any additional trials. We included RCTs that compared methods of timed intercourse using ovulation prediction to other forms of ovulation prediction or intercourse without ovulation prediction in couples trying to conceive. We used standard methodological procedures recommended by Cochrane to select and analyse studies in this review. The primary review outcomes were live birth and adverse events (such as depression and stress). Secondary outcomes were clinical pregnancy, pregnancy (clinical or positive urinary pregnancy test not yet confirmed by ultrasound), time to pregnancy, and quality of life. We assessed the overall quality of the evidence for the main comparisons using GRADE methods. This review update included seven RCTs involving 2464 women or couples. Four of the five studies from the previous review were included in this update, and three new studies were added. We assessed the quality of the evidence as moderate to very low, the main limitations being imprecision, indirectness, and risk of bias. Urinary ovulation tests versus intercourse without ovulation prediction Compared to intercourse without ovulat