Planned Coitus with Follicular Monitoring, also known as Timed Intercourse (TI) is a Scheduled Intercourse around your “fertile window”. This is one of the low-intervention – basic fertility treatment options recommended to couples who are unable to conceive naturally.
What is Fertility Window
Why is it needed?
Pre requisites for TI
2 types of TI
What is Fertility Window
Stages of menstrual Cycle and Fertility Window.
The fertility window is the best days of the month for getting pregnant. The chances of getting pregnant increase five days before you ovulate, and you reach peak fertility on the day before and the day of ovulation. In women with regular 28–30-day menstrual cycles, they are likely to ovulate around day 14 or 15, day 1 being the first day of your period. But this can vary from woman to woman.
So , couples who are trying to conceive, can increase your chances of conception by understanding the Fertility Window and Timing intercourse around those days.
Why is it needed?
As simple as it may seem, Ovulation prediction is not so easy for all couples. Especially in women with irregular periods or women with anovulation (women who do not ovulate). These women need more precise prediction methods like using medicines to help induce ovulation and tracking the follicular growth via a series of USG TVS scans and in correlation with the Estrogen and LH hormone levels to identify the time of ovulation. At the time of ovulation there is a spike in LH and Estrogen levels and the ovulation can be confirmed via an USG scan. Once this is confirmed Timed Intercourse is advised.
Pre requisites for TI
Pre Requisites for Timed Intercourse
As fertilization occurs in the fallopian tubes and the ejaculated sperm needs to travel from the vagina to the tubes to fertilize the eggs; it is therefore very important that:
In The female partner, the tubes are open
The Female partner has a good ovarian reserve
The Female partner has Healthy uterine cavity
The Male Partner must be able to ejaculate a normal semen sample.
2 types of TI
TI + Ovulation Induction cycle – Scheduling intercourse in combination with Ovulation Inducing Medications
This is the preferred option for women with ovulatory disturbances. TI is combined with ovulation inducing oral medications such as Clomiphene Citrate or Letrozole to get a better control of the follicular development and ovulation. More aggressive medications, such as Follicle Stimulating Hormone in the form of once-daily injections, can be given for some women who are resistant to ovulation induction using oral tablets, with careful monitoring.
In some cases ovulation can be triggered by giving trigger injections when the follicle has reached an appropriate size. The ovulation is expected to occur within 36 hours of administering trigger, and accordingly the couple is asked to time their intercourse.
Natural Cycle TI – Scheduling intercourse during a natural cycle (without any stimulation medication). In a natural cycle TI
Where spontaneous ovulation is allowed, once the ovulation is confirmed via a scan, you will be advised to have sexual intercourse for the next 3-5 days to help maximize the chances of fertilization.
Irrespective of the way, Timed Intercourse in itself is the simplest and non-invasive fertility “treatment,” available.
Procedure
Step-by-Step Guide to Planned Coitus (Timed Intercourse) with Follicular Monitoring
Remember, this is a general guide, and each couple’s situation may require different approaches or additional interventions. Working closely with a fertility specialist will ensure you receive the most accurate and personalized guidance throughout the process.
1Baseline scan on Day2 of period
Report to the clinic on day 2 of your periods. You may undergo a baseline scan to check how many antral follicles you have in each ovary and to ensure there are no abnormalities in your uterine cavity, endometrial lining, or ovaries.
2Controlled Ovulation Induction with Fertility drugs
If you are undergoing TI + Ovulation Induction cycle, you will need to start taking fertility medications from day 2 to stimulate the ovaries. These medications are usually taken for a specific duration, often 5-10 days, and dosages are personalized to each individual.
3Follicular Monitoring
The period from Day 2 to Day 14 is called the follicular phase , during which some follicles contained within the ovaries start proliferating and one of them will relase a mature egg. During your follicular monitoring, you’ll undergo periodic Transvagial ultrasound scans (atleast 4-5 scans) to assess the size and number of developing follicles and examine the endometrium (womb lining), along with some hormonal tests, which will help your fertility specialist identify your ovulation window.
4Trigger Shot
Once the pre-ovulatory follicle also called a graafian follicle reaches a desirable size, your doctor may administer a hormone injection called a “trigger shot” (e.g., human chorionic gonadotropin or hCG). This injection triggers the final maturation of the egg within the follicles and the release of the egg. Ovulation is typically expected to occur within 24-36 hours of administration of the Trigger shot.
5Timed Intercourse
Your doctor will provide specific instructions on when to have intercourse following the trigger shot. Typically, they will recommend having intercourse within a specific timeframe, usually within 24-48 hours after the trigger shot.
6Progesterone support
Following the planned intercourse, a patient may be prescribed daily supplementary progesterone — usually in the form of a capsule put twice daily into the vaginal canal — to help the uterus’ endometrial lining and embryo implantation.
7Pregnancy Test
A pregnancy test is conducted two weeks after ovulation. Because of the hormone given via the trigger shot, pregnancy tests conducted before two weeks may report a false positive. You can take a home pregnancy test or visit your doctor for a Serum Beta hCG test to check for pregnancy. If the test is positive, your doctor will likely schedule follow-up appointments to monitor the progress of your pregnancy.
It is important that both partners complete their Basic Fertility evaluation to rule out any tubal blocks or utrine abnormalities that might interfere or hinder the fertilization inside the fallopian tubes.
Husband needs to undergo semen analysis test before starting a TI cycle.
After intercourse, there’s no need to change your routine significantly. It’s essential to maintain a healthy lifestyle, eat a balanced diet, and avoid excessive stress. It’s also advisable to avoid any substances that may interfere with fertility, such as smoking or excessive alcohol consumption.
If you are trying to conceive naturally, that is without ovulation prediction- your chance of conception per cycle can be15 -20% Outside the Ovulatory window your chance of conception is zero, but timing your intercourse within the ovulatory window can double your odds of conception.
The goal of controlled Ovarian Stimulation is to have a singleton pregnancy rather than a high-risk multiple pregnancy. So, the doctor also checks for the risk of OHSS or Ovarian Hyperstimulation Syndrome (development of multiple follicles that are likely to ovulate) in which case the cycle may be discontinued. The doctor also keeps an eye on egg growth to determine the optimal time to give you a trigger injection to induce ovulation.
If a cycle fails, a new cycle with different medication levels can be tried. After no more than three timed intercourse cycles, patients are often ready to go on to more extensive treatment alternatives.
It is recommended that couples may talk to your fertility specialist about the next step. If tracking signs of ovulation and scheduled timed intercourse hasn’t helped them to conceive:
within 12 months if the female partner is under 35
or within six months if if the female partner over 35,
Depending on the specific diagnosis of the couple, the next stage in treatment could be advanced fertility assessment /Minimal Access Surgery / IUI or IVF. Throughout this process, a fertility specialist shares all the alternatives with the couple and their chances of success.
Pregnancy test is taken two weeks after ovulation
Another cycle (optional) may be pursued with adjusted medication levels in case the cycle is unsuccessful
IUI or IVF based on patients’ individual diagnosis
Frequently Asked Questions (FAQ’s)