Fertility experts have warned that modern couples are often too distracted or time-poor to have the amount of sex necessary to conceive naturally. Photo / Andrik Langfield, Unsplash
OPINION:
There's a question that is frequently brushed over in fertility clinics and it may well surprise you: how frequently do you have sex? You might assume that by the time a couple seeks IVF they have long been trying to conceive in the bedroom. But although the sex question is on the forms during many fertility consultations, it has become the elephant in the room.
This week, experts warned that modern couples are often too distracted or time-poor to have the amount of sex necessary to conceive naturally. Many, they added, end up having IVF not because they are infertile, but because they are time-poor.
"People don't make the time because they are too busy and too tired – they have a poor work-life balance and sex starts to seem like another chore," says Charles Kingsland, of clinic group Care Fertility. "There is no doubt that some people are opting for IVF simply because sex isn't something they have time to do."
"Modern life has taken the joy out of it and there are too many other things like emails and work competing for our attention," notes Professor Allan Pacey at the University of Sheffield. "Couples that I see now have very different expectations of what a healthy sex life is."
So-called Silicon Valley tech bros, meanwhile, are taking the idea even further, suggesting the idea that "sex is for recreation; science for procreation". Hank Greely, director of Stanford Law School's Center for Law and the Biosciences, has predicted that we'll have stopped having sex to make babies within the next 30 years, instead picking from a petri dish of embryos created in a lab, using a couple's DNA.
The current decline in sex is nothing new, but it's one that IVF clinics have ignored for years – and it appears to be worsening. In my work supporting couples and individuals towards parenthood, I often notice the subject has fallen by the wayside. As, it appears, has sex itself. Many couples have told me: "You're the first person to ask."
I remember one pair who had been celibate for two years. They had been advised by the private clinic they visited to go straight to IVF – a process that would cost them thousands of pounds – with no questions asked.
My view was that it would be better to address the central issue, and consider IVF later and if necessary. We discussed the emotional backdrop, her past history of abuse and put together a treatment plan that included acupuncture, counselling and lifestyle changes (such as no electronics in the bedroom). They went on to conceive naturally.
For some patients I see, having a baby is the priority but having sex is not – and neither partner is interested in increasing how much they're having. Though that might sound incredible, it appears to be a reflection of our sex lives right now, with sexless relationships becoming more common. And not just among those trying for a family.
According to recent findings by French polling company Ifop, the proportion of British women who say they have not had sex in the past 12 months rose from 42 per cent to 46 per cent between 2016 and 2021 (the increase was even steeper in French women, from 31 per cent to 41 per cent). The latest UK data from the National Survey of Sexual Attitudes and Lifestyles showed fewer than half of those aged 16-44 were managing to have sex at least once a week.
The reasons for this are complicated and go beyond a lack of time. Financial worries, Netflix, social media, technology in the bedroom and longer working hours are all contributing factors that didn't impact our parents or grandparents generations.
And when it comes to baby-making sex, even the most sexually committed couple will tell you that peeing on sticks, looking at apps and googling every twinge only adds to the inertia. The change from "I want you" to "we're trying" can be the death knell for fun sex.
Some are able to keep the spontaneity for a while, but if it takes too long then sex becomes another item on the to-do list. Despite three times a week being the recommended amount for those trying to conceive, I've found that many couples limit sex to "fertile days" and don't touch one another for the rest of the month.
Devices such as ovulation sticks can, ironically, reduce the number of times that couples have sex in a month. A few years ago, I conducted an audit in my clinic comparing couples who used ovulation sticks and apps, with couples who didn't. The results were very revealing: those who used the ovulation aids were having 20 per cent less sex, and were more anxious, than those who didn't.
Over the past three decades, I've witnessed another change in behaviour: expectation. Women, in particular, can be driven by a need to "get everything right", which has its roots in perfectionism and is exacerbated by social media comparison culture and elements of the wellness industry.
They can put themselves on a relentless, joyless treadmill of self-improvement, removing anything from their lives that previously gave them pleasure. The act of conception has become something else to be perfected and conquered. But the impact of creating a less joyful life in pursuit of starting a family undoubtedly impacts sexual desire.
Where time can become a factor is when it's applied to age. In 2020 the average age of mothers giving birth to their first child in England and Wales was 29, and rising. When your window for natural conception is closing, IVF might seem like a shortcut. Indeed, my generation was told not to get pregnant at any cost – babies can wait, put your career first. It means that over recent years, IVF has been oversold as a fertility cure-all. This is far from reality; medically or financially.
I have enormous compassion for those for whom conception takes longer than average (up to two years is still considered "normal"). The pressure of trying and not succeeding is heartbreaking. Relationships are tested to breaking point; couples tell me how it has changed their bonds with friends and family.
So does it matter if couples want babies without sex? Britain has a falling birth rate – declining from a high of 2.93 births per woman in 1963, to 1.65 by 2019. Were it not for immigration, our population would be in freefall. You only have to look at the crisis in countries such as Japan and Korea to see what could be in store if this trend continues.
Plus, IVF is an incredible intervention when used in the appropriate way. I have witnessed countless couples and individuals become parents because of it. We have brilliant fertility specialists, embryologists and modern laboratories in the UK; with some treatments available on the NHS. But it is arguably unscientific to offer IVF when lack of sex is the cause and not infertility. It's a roundabout solution to a lack of libido and a very extreme one for most.
But even beyond babies, we must continue the conversation about our national sex drought. I knew those predictions of a lockdown baby boom would prove to be wrong – since when did fear, financial stress and being together 24/7 get people in the mood?
Sex remains an important part of life regardless of if you are hoping to conceive or not. It is an invitation to intimacy, it regulates our nervous system, nourishes our relationships, releasing endorphins, dopamine and serotonin. Sex is good for us and in our ever controlling world, letting go occasionally remains an important part of our humanity.
• Make time for each other away from work emails, Netflix and social media. Ban electronic equipment from the bedroom.
• Perfectionism is a real block for many. Drop the comparisons, compliment each other's bodies and reduce the expectation to be waxed and toned. Something has to give, but don't let it be the sex.
• Forgive yourself and your partner if one of you does not have the energy for sex. Find other ways to show affection, and find ways to ensure you will have energy on another night.
• Emma Cannon is a fertility mentor and acupuncturist and author of The Baby-Making Bible and Fertile
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