Welcome to Dr. E’s Frequently Asked Question page. We
have taken our communities most often asked questions
on: male fertility; how to enjoy intercourse while
trying to make a baby; and how to optimize your Pre~Seed
use, and posted answers for you here. This list will grow
as we go forward, so check back often! If you have a
question you would like answered, please email us at
Thanks for being a part of our Pre~Seed family and happy
provides moisture without harming sperm.
For use even while trying to
conceive – a time of increased vaginal dryness when
other products should be avoided due to their
detrimental effects on sperm.
Mucus Quality, Clomid and Sperm Transport?
have read information about the maximum amount of time
that sperm can survive in fertile cervical mucus (CM).
Can you tell me the maximum amount of time sperm can
survive in non-fertile CM, like sticky or creamy? Is it
only a problem in the vagina and once the sperm makes it
into the uterus it can survive for several days? Or, is
it that sperm can only make it from the vagina into the
cervix if there is fertile CM?
ejaculation, sperm have to be able to swim through the
cervix to reach the Fallopian Tube where fertilization
of the egg occurs. The sperm that can fertilize the egg
begin leaving the ejaculate within 1 min after
deposition, and no sperm that get to the Fallopian Tube
have ever been proven to do so after 30 min of
ejaculation. The "cervical reservoir" of sperm is not an
actual pool of fertilizing sperm.
Sperm have to get thru CM to get to the Fallopian tube
where they are then stored for hours to days until the
egg comes. However, the interactions of sperm and
cervical mucus that allow this migration are often
disrupted in fertility patients. It is thought that at
least a third (if not more) of subfertile couples have
some disruption of sperm-cervical mucus interactions
that limit sperm transport to the tubes.
The importance of normal CM in natural reproduction is
widely recognized. For most of a woman’s cycle the CM is
a thick gel and hostile to sperm, with a low pH and a
structure that stops sperm transport by the presence of
closely spaced microfibers. During ovulation, however,
the CM becomes more alkaline (higher pH), and the fibers
align in parallel with an expanded distance between
them. This allows the sperm to swim through the mucus.
Normally, the volume of daily CM also increases 5 fold
at ovulation. CM is a hydrogel of 90% water, and its
primary function appears to be bathing sperm in a fluid
medium to protect them during transport . The presence
of sugar-proteins in the gel that hold the water is
controlled by hormone changes at ovulation (especially
the presence of estrogen). These sugars increase the
mucus gel’s capacity to hold water, expand fiber
spacing, & allow sperm migration. Taken together, these
changes permit sperm to rapidly swim through the cervix
and proceed to the Fallopian tube for fertilization.
In women with poor sperm-CM interaction there is a
reduction in CM fiber spacing making sperm migration
difficult, a primary cause of which in many women may be
inadequate water in the gel. This may be caused by
advancing age (with low grade hormonal disruptions); and
following the use fertility medication such as
clomiphene citrate (CC or clomid). CC is a widely
prescribed fertility drug. In fact, it has become
increasingly used as a first line therapy for couples
with fertility issues. With easy internet access, many
women are also taking CC without doctor oversight.
Estimates are that 40% of couples with fertility
problems utilize CC at some point for the woman.
Although it’s wide spread use has helped many couples
conceive, it does cause significant problems with
vaginal dryness and CM production and function.
Specifically, numerous studies have shown that CC causes
decreases in: volumes of CM; quality of CM (“egg-white
like appearance”); and sperm penetration into CM. In
fact, women on CC are seven times more likely to have
“hostile” CM that is difficult for sperm to penetrate
than are women not on the medication.
Women on CC also have an increased prevalence of vaginal
dryness, which can cause pain at intercourse and
decrease enjoyment for the man (which can decrease sperm
counts). Many women on CC (which is already making them
prone to poor sperm-cervical mucus penetration) are
therefore also using lubricants that can harm sperm such
as KY, Astroglide and Replens. These women may be
creating a vaginal environment that limits sperm
transport. Pre~Seed “sperm-friendly” Intimate
Moisturizer can replenish vaginal moisture without
harming sperm. A clinical trial is also planned to
evaluate the effect of Pre~Seed on sperm and cervical
mucus interactions, especially for women on Clomid.
to Abstain for a Sperm Test/Analysis
Recent studies suggest that abstaining for a
sperm test or a procedure such as IUI/IVF should be
limited to no more than 1- 2 days. The first study
looked at men with abnormal sperm (oligospermic) and
found the best sperm quality occurred at 1 day of
waiting or abstaining prior to production. For men with
normal sperm waiting more than 10 days between
productions resulted in abnormal sperm quality.
In the second study that looked at functional quality
(i.e. “did the sperm result in an artificial
insemination IUI pregnancy”, they found:
”Abstinence correlated positively with inseminate sperm
count but negatively with motility.”
meaning that abstinence increased sperm count but
lowered motility... who cares the number of sperm if
they can't swim!
”Variations in inseminate parameters did not correlate
with pregnancy rates”.
How the sperm looked on testing did not relate to
pregnancy outcomes - discussed in the FAQ on doing sperm
However, abstinence intervals significantly affected
”The time of abstinence impacted outcome. Couples that
had 10 or more days of waiting had only a 3% pregnancy
Based on these studies 1-2 days wait before production
is probably best.
Fertil Steril. 2005 Jun;83(6):1680-6.
Relationship between the duration of sexual abstinence
and semen quality: analysis of 9,489 semen samples.
Fertil Steril. 2005 Sep;84(3):678-81.
Related Articles, Links:
Effect of ejaculatory abstinence period on the pregnancy
rate after intrauterine insemination.
went to my pharmacy and they did not carry Pre~Seed.
Where can I find it and why is it so hard to locate?
is carried in around 150 pharmacies, sexuality centers
and medical clinics in the US and Canada. You can find
locations near you by going to
http://www.ingfertility.com/providers.html. Pre~Seed is made with unique ingredients, in a very
detailed and controlled manufacturing process. It is
also the only vaginal dryness relief product that has
each lot tested with human sperm to ensure there is no
sperm damage. I also personally try a sample of each lot
prior to its sale, to ensure that the product is mild
and non-irritating (I am very sensitive to other
lubricant products). Taken together, we have found that
independent pharmacies and medical clinics tend to
understand the unique properties of Pre~Seed better than
the large chains, and have provided better service for
product distribution for us. Someday I am sure we will
be more easily found!
But for now, check for stores at your location at our
website. Or you can easily order on line or by phone!
Our packages come to you and are charged to your credit
card with no description of contents (under the name ING).
Transport to the Fallopian Tubes
If a man has normal sperm count and normal sperm
motility, approximately how many sperm will be able to
get to the fallopian tubes for each ejaculate during a
woman's ovulation period? I've read different
information on this. Some said about 1000 sperm to 5000
sperm but some said only about 50 sperm to 200 sperm.
is actually a very good question, one only a handful of
scientist around the world (including myself) have spent
our careers studying.
Here is the issue-- Prior to the 1990's several good
studies were done looking at sperm in the tubes after
insemination, by flushing the tubes with salt water and
counting the sperm. But back then we hadn't done the
studies I did on my PhD, (along with others) to show
that sperm actually bind or stick to Fallopian tube
cells, and that they stay stuck even if you rinse the
tube. These stuck sperm are released in waves over time,
so there will always be sperm available to meet the egg.
Once sperm are released from the tubal cells they either
meet an egg or they die within a few hours as they are
"capacitated". This gives a supply of ready sperm as
they wait for the egg for days to a week plus.
These early studies showed really low sperm numbers in
the tubes- 1 out of every 14 million inseminated sperm
got inside the tube, and only 1 of every 2000 sperm
inseminated made it into the cervical mucus (Settlage et
Likely, there were other sperm in the tubes in these
studies that were attached to the tubal cells and
therefore, not counted. Since the 1990's though the kind
of studies you can do in people have drastically
changed. It is almost impossible to get permission to
have a couple have unprotected intercourse at ovulation,
and then surgically remove a portion of the tube to
study for counting sperm attached to the tubal cells.
You could be setting up a tubal pregnancy.
For this reason, when I had my tubal ligation I took
estrogen (to mimic ovulation), had intercourse and then
24 hrs later had a tubal and my tubes removed to look by
scanning micrograph for the sperm attached to the tubal
cells. I found about 20 sperm in the portions of the
tube I looked at. Just call me Madame Currie!
So... no one knows the answer to your question for sure.
In animals, where we have done many studies -- only
hundreds of sperm are in the tube (even though their
ejaculates can have up to 350 million sperm in them).
One other thing I have found is that with stallions, the
number of sperm that attach to tubal cells in culture
(laboratory) is very, very highly correlated to their
ability to impregnate mares (r=0.80). The stallion is a
great model b/c they may breed 20-60 mares a season so
you can get good pregnancy data on more than one female,
and compare that to sperm function.
In men, I have seen a wide range of ability of sperm to
attach to tubal cells in culture as well. Some men have
almost no sperm attaching and they die quickly within
hours, while some men have a very high attachment rate
and survival rate with sperm living attached to the
tubal cells for up to 9 days in the laboratory. This
correlates with what has been in seen in women with live
sperm found in one woman’s tubes 21 days after
Extrapolating from the well done stallion study, we can
assume that the men with the most sperm attaching to the
tubal cells and therefore living the longest, will have
the highest fertility.
Thanks for asking a fun question!
Leaking Out After Intercourse- Lessons in Sperm
Transport Through the Cervix
Q: Why does
sperm leak out sometimes and not others? Does it mean
the cervix is closed? Or there is more sperm sometimes
than other times? If a lot leaks out, does that mean
there was a lot of sperm? Is there any way to prevent it
A: In a 5
yr study of 11 women (Baker & Bellis, 93), sperm loss
after intercourse ("flow back") was observed- Flow back
occurred 94% of the time, with an average loss of 35% of
the sperm. It is totally normal and is not a sign that
there is anything wrong. It is more pronounced the
larger the ejaculate volume, and remember ejaculate
quantity is impacted by "how turned on" your husband is.
So if you have a great session, or it has been awhile
seeing doing the deed, there will be more.
The sperm that penetrate into the cervical mucus begin
to do so within 1.5 min, and they are pretty much done
by 30 minutes, with no gain in sperm numbers in the
cervical mucus or Fallopian tubes after 45 min from
intercourse. Only thousands of the millions of sperm
ejaculated in the vagina make it to the cervix and only
hundreds of these make it to the Fallopian tube!
The very best of the best get there, the rest get washed
out- it is OK!
Understanding a Sperm Analysis
Sperm analysis or tests are a critical
part of finding out what why a couple may not be
conceiving. Male low fertility is usually involved about
60% of the time, with 40% of the time the man being the
main cause and 20% of couples having shared male and
First of all the results of a sperm analysis are your
medical records and you have the right to them, and the
right to a good conversation of what was found. I am
surprised how often people don't get reports back or how
poorly the material is reported back. YOU need to be
aggressive about talking to your doctor and
understanding what they found. YOU also have the
responsibility of making sure your clinic is using state
of the art methods to look at DH's (darling husband’s)
sperm. If not, find another clinic! One recent study
showed that showed only 30% OF ALL CLINICS doing sperm
tests in this study had accurate readings of motility
That said it is important to understand that there is NO
sperm test that can tell you if a couple will conceive
or not - except if there are no sperm in a man's semen-
then of course the chance is zero.
There have been thousands of studies with every one
wanting a magic bullet that says "this ejaculate can
make a baby, this one can not". NO SUCH Test exists.
What we do have is studies relating various quality
sperm to various levels of fecundity (this means the
chance of conceiving). Men with normal sperm parameters
in regards to count, motility, and morphology (shape)
tend to have normal chances of impregnating their wives
(20-30% chance each month). Although other things can be
wrong with sperm that appear normal at sperm analysis.
The chromatin (DNA) can be damaged, there can be
antibodies etc... Meaning that just b/c DH has a normal
basic sperm analysis does NOT guarantee he is "fertile".
Many couples with unexplained infertility have stopped
evaluating the man because he has normal parameters on a
semen analysis. This is not good medicine.
Infertility with normal sperm counts: If your DH has a
normal sperm analysis, but you have been trying over 12
months, or 9 months and the woman is 35 or older & there
are no obvious female factors...you need to see a
Clinical Andrologist- a male sperm specialist- NOT an RE
to look deeper into more subtle sperm defects.
On the other side, an abnormal sperm count does not mean
your husband is sterile- sterile means NO functional
sperm in the ejaculate. It truly does only take one
normal sperm and we have all heard of couples that could
not conceive for years and years due to male factor, who
suddenly do become pregnant. Lower quality sperm,
meaning outside of average, means your fecundity or
chance of conceiving each cycle drops. There is one
recent study with Dr. Kruger as an author (i.e. Kruger's
strict morphology criteria) that studied all the other
studies and basically said that you can break ejaculate
quality into "fertile" or "subfertile" based on
"thresholds of <5% normal sperm morphology, a
concentration <15 x 10(6)/ml, and a motility <30% should
be used to identify the subfertile male”.
You will note that this study used the strict criteria
for morphology - Other forms of looking at sperm shape
are not as accurate or predictive of subfertility.
Subfertile doesn't mean sterile- it means your chances
are less and as you move to worse and worse quality the
chances continue to decline somewhat.
Infertility with abnormal sperm analysis: If you have
this situation you need to repeat the sperm analysis to
confirm accuracy. I NEVER use a first sperm sample even
in my totally normal young volunteers in my studies- b/c
the first time a guy performs in a cup- the sperm are
usually bad!!!! A recent study showed that sperm
motility, and counts differed AMAZINGLY for monthly
sampling over a year from the same guy. Four times, even
17 times! the number of sperm in an individual
ejaculate. The only parameter that did not vary was the
percent of morphologically normal sperm - the shapes.
The one caveat here is that these guys all collected
into a cup - probably dry handed (without lubricant).
Numerous other studies have shown that you can improve
the normal morphology % using collection into a condom
during intercourse based on the man being more
It is also important to note that sperm counts and
quality decrease as your DH ages over 45 yrs...see
below. Another study has shown that sperm DNA quality
also goes down after age 45. SO... if your DH is older
for sure really stimulate him for any semen collection.
Try to make it as exciting as possible and think about
using that collection condom.
Also, many, many studies have suggested the benefit of
antioxidants in men that are trying to conceive. I have
posted one here that looked at it the other way -
instead of an effect of vitamins on sperm quality- they
looked at fertile versus infertile guys and found that
the fertile guys had more antioxidants in their semen.
So any man with a poor semen analysis should be put on
fertility vitamins with antioxidants such as FertilAid.
Sperm Collection Condom?
friend told me about using a condom to collect sperm for
our IUI. What does this require and why would you use
choose this message?
is a copy of a newsletter that I wrote on this subject.
Semen Collection by Masturbation vs. Intercourse with a
Millions of sperm samples are processed each year for
both diagnostic procedures (to determine sperm quality
in a man) and therapeutic interventions, such as
intrauterine insemination (IUI) and in vitro
fertilization (IVF). The majority of these samples are
collected manually by masturbation. However, this method
can cause a great deal of stress in men, and it can lead
to production of inferior sperm samples, with lower
sperm counts and motility resulting. Whether men morally
object to masturbation to collect semen, or if the whole
process of performance "on demand" is too much to allow
for good sample collection, numerous studies have shown
that collecting sperm in a condom during intercourse is
an excellent alternative to masturbation.
Data Supporting Sperm Collection Using Condoms at
Studies over the last three decades, have shown that
sperm quality can be strongly impacted by collection
method, especially in oligospermic men (men with low
sperm counts). A review of the published literature
shows that total sperm counts, sperm motility, and the
percentage of sperm with normal morphology are often 2-3
times higher in samples collected in condoms at
intercourse than by masturbation in the same men (Sofikitis
& Miyagawa, Journal Andrology, 1993). Sperm function
tests like hamster zona penetration or membrane swelling
are also significantly improved for sperm from condom
collection versus masturbation. In fact, in one study (Zavos,
Fertility & Sterility, 1985), 38% of the patients that
were classified as having low sperm counts based on
masturbated sperm samples, were reclassified as normal
after semen collection at intercourse in a condom.
Furthermore, in this study, the total functional sperm
fraction (numbers of normally shaped motile sperm in the
sample) increased by 190% in oligospermic patients, and
69% in normospermic men.
In these studies sexual satisfaction at collection is
also greatly increased, lessening the stress of the
collection process. In fact in one study, patients
preferred condom use so much over masturbation that the
scientists had to stop randomizing collection method and
only have men collect at intercourse AFTER the
masturbation collections were done, or the men would
stop participating in the study!
In general, all studies comparing masturbation to condom
collection of sperm have found that those sperm
parameters historically associated with and related to
fertility show improved outcomes when collected into
condoms at intercourse. Sperm samples collected by
masturbation, therefore, do not represent the optimum
quality sample a man can produce and may lead to
diagnostic mistakes and/or lowered success rates in
This is especially important for sperm samples to be
used in assisted reproduction techniques such as IUI,
where total motile sperm count critically impacts
successful outcomes. For men with borderline sperm
sample quality, using a condom at intercourse instead of
masturbation could provide significant clinical benefit
by increasing the potential fecundity rate (the chance
of conceiving per cycle) as the number of motile sperm
inseminated is increased.
These previous studies have lead one clinician to write
"It appears that for cervical cap insemination,
intrauterine insemination, and IVF coitus condomatus
(collection into a condom) is preferable to regular
masturbation" (Gerris, Human Reproduction Update,1999).
He further concludes, that for "artificial reproductive
technology, masturbation as a method for semen
collection should not be recommended".
Specially Designed Condoms for Sperm Collection
Almost all commercially available condoms are made
of latex. Latex condoms have been shown to be toxic to
sperm and never should be used for sperm sample
collection. In contrast, two types of condoms are
approved for sperm collection. These include silastic
(silicone rubber) condoms manufactured by HDC
Corporation (Mountain View, CA) and polyurethane condoms
manufactured by Apex Medical Technologies (San Diego,
CA), called the "Male Factor Pak". Both of these types
of condom are sold by several fertility supply
companies, including INGfertility (the makers of
Previous Problems with Sperm Collection Condoms
In spite of all of the studies discussed above, many
people are unaware of the possibility of using a special
condom during intercourse with their partner for sample
collection. Part of the reason for this, is that many
doctors became discouraged with these condoms due to
patient frustration with them. In the past, patients had
a difficult time using the condoms due to vaginal
dryness and lack of lubrication, leading to pain and
performance issues. Previously available vaginal
lubricants harm sperm and could not be used with the
condoms. This made both intercourse and removal of the
condom difficult and at times painful. I am aware of
numerous couples who tried the semen collection condoms,
only to have to stop during intercourse because of pain
from the lack of lubrication.
A Solution to Non-lubricated Semen Collection Condoms
Pre~Seed Intimate Moisturizer has been specially
formulated to not harm sperm while replenishing personal
moisture. It can provide moisture both in the vagina and
on the penis, inside the condom to facilitate
intercourse and sample collection. The Pre~Seed formula
has been tested and is compatible with the Apex condoms
(we have not yet evaluated the silastic condom).
INGfertility is now offering a Sperm Collection Kit
including the approved condom and a Pre~Seed applicator
to optimize the collection process.
Couples who plan to use condoms to enhance sperm quality
for assisted reproduction procedures such as IUI should
practice at least once with the condom and Pre~Seed to
learn how to best use the system, without the stress of
the procedure hanging over them. Additionally, a new
(but very small) study has suggested that it is best if
couples can get their semen sample to the laboratory 30
minutes after collection. For couples who live a
distance from their clinic, renting a hotel room may
offer a more romantic and enjoyable experience for
condom collection, than having to rush out the door at
home. Finally, individuals need to make sure their
laboratory has experience with sperm samples in condoms.
They will need to rinse the condom in order to optimize
sperm recovery. It is perfectly acceptable for any one
to ask to have this done!
Assisted reproduction procedures, such as IUI, all have
tremendously variable outcomes based on the clinic and
technique used. In general, cumulative pregnancy rates
for 3 cycles of IUI should equal rates of an IVF cycle
at around 25%. Three cycles of IUI is actually more cost
effective for couples with unexplained infertility and
moderate male factor infertility, than IVF. The most
important thing a couple can do to optimize their
chances for conception is to increase the number of
motile sperm in the ejaculate. The best option for doing
that is likely through condom collection of sperm at
intercourse - where the couple can function as a team
the way it was meant to be!