Sex After Failed Conception Attempts

Because that drop is one of the documented features of an unsuccessful cycle, and it has been measured. ESHRE's 2015 guideline on routine psychosocial care in infertility states that women experience lower sexual satisfaction after the pregnancy test than before the start of an IVF or ICSI cycle, graded level B, and that patients experience high emotional distress when they are informed that the treatment was unsuccessful, also level B. Nothing about that requires an explanation specific to you or your relationship.

The same guideline puts numbers on the state most people are in at that moment. When told treatment was unsuccessful, 1 to 2 in 10 women experience clinically significant levels of depressive symptoms. After receiving the pregnancy test result, 1 in 4 women and 1 in 10 men have a depressive disorder, and 1 in 7 women and 1 in 20 men have an anxiety disorder. Desire and arousal are not independent of that.

Two things follow. The first is that this is a reaction with a known time course rather than a new diagnosis. The second is that it is not usually where treatment should start looking for a cause.

The evidence points at the sequence rather than at an underlying sexual disorder. ESHRE 2015 concludes that patients starting first-line or ART treatments do not have worse marital and sexual relationships than the general population (level B), and that patients in fertility workup do not present higher prevalence rates of sexual dysfunction than the general population (level C) — in the cross-sectional study behind that second point, 18% of 121 male partners had mild erectile dysfunction and 4% moderate, figures the guideline notes are not higher than general-population estimates.

Over the longer arc of infertility, though, sexual difficulty is measurably more common. A meta-analysis of 8 controlled studies found a higher prevalence of sexual dysfunction in men with infertility than in controls, pooled odds ratio 2.66 (95% CI 1.69 to 4.19), with erectile function, orgasm and desire the domains most affected (Liu et al, Sexual Medicine 2022;10(4):100528). In women, a meta-analysis of 11 comparative studies found infertility associated with an increase in sexual dysfunction, with lubrication, orgasm and satisfaction the affected domains (Mendonça et al, European Journal of Obstetrics and Gynecology and Reproductive Biology 2017;215:153-63).

A systematic review of 170 publications concluded that loss of sexual desire and erectile dysfunction are among the most frequent sexual disorders resulting from infertility, while also stating that the available literature reflects the complexity of this only fragmentarily (Leeners et al, Human Reproduction Update 2023;29(1):95-125). That is the honest summary: the direction is consistent, the precision is not there.

For a substantial minority it is measurable. In 236 male partners of couples with more than a year of infertility, 109 of 236 (46.2%) reported higher stress relating to sexual function during the fertile period than outside it, while 122 reported no difference (Song et al, BJU International 2016;117(1):173-6). So roughly half notice the schedule and roughly half do not, which is worth knowing if one partner feels it far more than the other.

A cross-sectional study of 509 men attending for a couple's infertility assessment found erectile dysfunction more common among men who had known for at least six months that their sperm parameters were impaired: odds ratio 1.86 (1.07 to 3.24) for mild to moderate impairment and 5.31 (2.69 to 10.49) for severe, against men assessed recently or not at all. Timed intercourse was reported by 44 of 156 men (28.2%) in the mild-to-moderate group and 17 of 66 (25.7%) in the severe group, against 20 of 170 (11.8%) in the recently assessed group (Yu et al, Reproductive Biology and Endocrinology 2022;20:139). The pattern is association, not proof of direction.

What makes loosening the schedule reasonable is that the arithmetic barely moves. ASRM's 2022 committee opinion reports cycle fecundity was similar for intercourse daily, every other day and even every 3 days in the fertile window, and lowest only when intercourse occurred once in that window; it adds that specific recommendations about frequency may induce unnecessary stress, and that the optimal frequency is best defined by the couple's own preference within that range.

Longer than the fortnight after the result, and not indefinitely. In a longitudinal study of 148 IVF patients and 71 partners, women's anxiety and depression rose after unsuccessful treatment and showed no recovery over the following 6 months; at follow-up more than 20% of that cohort still had subclinical anxiety or depression, while men showed no change on those measures after either outcome (Verhaak et al, Human Reproduction 2005;20(8):2253-60).

A systematic review of 25 years of research reached the same shape: women starting IVF differed only slightly from norm groups, unsuccessful treatment raised negative emotions and those continued after consecutive unsuccessful cycles, most women nonetheless adjusted well, and when IVF resulted in pregnancy the negative emotions disappeared (Verhaak et al, Human Reproduction Update 2007;13(1):27-36).

Further out, ESHRE 2015 records that about 2 years after unsuccessful IVF or ICSI treatment patients are generally satisfied with their marital relationship (level C). The same guideline also records, at that lowest evidence grade, that former patients still childless 5 years after unsuccessful treatment are three times more likely to separate than those who became parents by adoption or spontaneously — an association drawn from follow-up studies, not a prediction about any particular couple.

What the result itself does and does not tell you about the next cycle is a different question, covered in After a Failed IVF Cycle: What Is Worth Investigating.

ESHRE 2015 makes referral the recommendation rather than self-management: fertility staff should refer patients who, when ending unsuccessful treatment, experience or are at risk of clinically significant psychosocial problems in the short or long term to specialised psychosocial care, meaning infertility counselling or psychotherapy; should offer additional psychosocial care to those at risk of increased infertility-specific distress; and should offer patients the opportunity to discuss the implications of ending unsuccessful treatment. All three are good practice points rather than trial-based recommendations.

Two practical cautions sit alongside that. ESHRE records that offering the currently available interactive complex interventions is not likely to improve patients' interpersonal relationships or sexual concerns (level B) — so a general support programme is not the same as addressing this. And Leeners and colleagues note that addressing sexuality is not a standard component of infertility counselling, partly because sexual medicine is not a core element of specialist training in most countries, which means the subject often has to be raised by the patient before it is discussed at all.

It is also worth naming it in the room. ESHRE's guidance to staff is to actively involve both partners in the treatment process, and it records that in couples, the way one partner reacts to infertility and its treatment is associated with how the other reacts (level C). More on that pattern in Common Emotions Couples Experience During IVF.

This is a thinly studied area and several claims circulate well beyond what the sources support.

• That sex caused a failed implantation. One time-to-pregnancy cohort of 564 women aged 30 to 44 found cycles with two or more days of intercourse in the peri-implantation window less likely to produce a positive test in that cohort, fecundability ratio 0.62 (95% CI 0.42 to 0.91) (Steiner et al, Fertility and Sterility 2014;102(1):178-82). That was natural conception, observational, and the authors describe the effect as possible rather than established; it says nothing about intercourse after an embryo transfer.
• That sexual function after a failed transfer has been measured. No study retrieved here does that specifically. The ESHRE finding is about the period after the pregnancy test in an IVF/ICSI cycle, which is close but not the same thing.
• That a particular waiting period before resuming sex matters. Nothing retrieved here establishes a timing, in either direction, after an unsuccessful cycle.
• That a position, technique or frequency improves implantation. ASRM 2022 states sperm are found in the cervical canal within seconds of ejaculation regardless of coital position, and that there is no known relationship between orgasm and fertility.
• That stress explains the failure. The reviews here measure distress as a consequence of unsuccessful treatment; none of them establishes it as the cause of one.
• That the direction of effect is settled between infertility and sexual difficulty. Leeners et al describe the available literature as reflecting the complexity of these interactions only fragmentarily.

What is supported is limited and still useful: the drop is common, it was measured after the pregnancy test rather than invented, it does not indicate a sexual disorder in most couples, the schedule can be loosened at almost no arithmetic cost, and referral for counselling is what the guideline recommends when it does not lift. Related: Sexual Health and Fertility: What Couples Should Know.