Question 15. After we have sex, I think that everything comes out. Is this why I am not getting pregnant?

A few years ago I had a high school student spend the day with me in the office since he was considering a career in medicine. He went with me to Fairfax Hospital where I gave a lecture to the medical students and residents. He went with me to Reston to see some consultations. He went with me back to Arlington to watch some procedures including an embryo transfer (he was in the lab not in the room with the patient). I thought that he would be impressed by the depth and breadth of what I do all day long.....

At the end of the day I asked him what he thought of being a Reproductive Endocrinologist. He paused for a minute then blurted out "So basically you talk about sex and tell people when to do it." Oh well. So much for impressing him with the depth and breadth of my medical specialty. He wanted to be a heart surgeon anyway.....

But he was correct that we do have to talk about sex with our patients and that leads us to the Question of the Day just in time for the weekend! Hope all of you have a Happy Easter. He is risen indeed.



15. After we have sex, I think that everything comes out. Is this why I am not getting pregnant?


Honestly, this question is one of the most frequently asked questions that we get during new patient consultations. At the time of male orgasm, the ejaculate is composed of proteins, enzymes, and water from the seminal vesicles. The sperm represent only one to three drops of the total ejaculate volume of 1.5 to 5 mL. Following ejaculation in the vagina sperm rapidly move from the vagina into the cervical mucus, where they can live for 5 to 7 days. The cervical mucus serves as a reservoir for the sperm, from which they can subsequently travel to the upper reproductive tract and meet the egg in the fallopian tube.

It is normal for much of the ejaculate to spill out of the vagina following coitus. For most couples, this does not decrease their chances for pregnancy. Rarely, a woman may suffer from vaginal or uterine prolapse. The altered anatomic relationship may not hold enough of the ejaculate in close proximity to the cervix following coitus. Such conditions usually occur only after several previous vaginal deliveries.