The Effect of Ejaculatory Abstinence Interval on Sperm Parameters and Clinical Outcome of ART. A Systematic Review of the Literature

Since the publication of the first edition of the WHO (World Health Organization) Laboratory Manual for the examination of Human Semen in 1980, the reference values of sperm parameters have been updated on four occasions. Currently and globally, most of the laboratories analyzing semen samples use the latest, 5th edition of the manual that recommends ejaculatory abstinence from two to seven days before producing the sample for examination. While this standardized interval of time facilitates the interpretation of the results and research, no solid evidence exists to support the WHO-recommended abstinence time for a semen analysis in order to optimize clinical outcomes after assisted reproduction. Most of the studies refer to different clinical outcomes, different groups of patients and different editions of the WHO Laboratory Manual, including heterogeneous intervals of abstinence or sperm parameters. The aim of the current systematic review was to evaluate available evidence correlating ejaculatory abstinence time with clinical outcomes and sperm parameters analyzed according to the last edition of the World Health Organization Laboratory Manual reference values in different male populations. The results from the included studies indicate that WHO abstinence recommendations may need revision, given that a shorter ejaculatory abstinence interval appears to be associated with improved sperm parameters, such as sperm DNA fragmentation, progressive motility or morphology, while evidence suggests a potential increase in embryo euploidy rates and pregnancy outcomes.

P–031 The effect of ejaculatory abstinence period on embryological and clinical outcomes in ICSI cycles: A retrospective analysis of 3,353 cycles

Study question Does ejaculatory abstinence period in male affect embryological and pregnancy outcomes following fresh embryo transfers in ICSI cycles? Summary answer Shorter ejaculatory abstinence period is associated with lower triploid zygotes rate per ICSI cycle but it does not affect clinical outcomes after fresh embryo transfers. What is known already Lower sperm quality may negatively impact on fertilisation rate and embryo morphokinetic parameters after ICSI and the effect of the ejaculatory abstinence period before semen collection on seminal parameters and sperm quality has been widely reported. However, the impact of ejaculatory abstinence on clinical outcomes is still controversial. WHO (World Health Organization) guideline recommended that abstinence period should be 2–7 days. Even so, there are no larger prospective trials determining the optimal timing for ejaculatory abstinence period for infertile couples. Study design, size, duration This is a single center retrospective observational study of 3,353 fresh cycles from January 2017 to December 2020. Semen analysis was done according to the WHO criteria. Exclusion criteria for this study were frozen gametes and cycles with no retrieved oocytes. Primary outcomes were fertilization rate and triploid zygotes rate. Secondary outcomes were blastulation rate, ongoing pregnancy rate and live birth rate per fresh embryo transfer. Participants/materials, setting, methods The correlation between ejaculatory abstinence and continuous outcomes was evaluated by Spearman’s correlation analysis in order to detect potential non-linear associations. Generalized linear model and logistic regression were used, respectively for continuous and binary outcomes, in order to adjust for confounders such as female age, male age, number of retrieved oocytes, percentage of mature oocytes, infertility causes, seminal volume, sperm concentration and total progressive sperm motility. A p value <0.05 was considered significant. Main results and the role of chance The male mean age was 40.3±5.5 and mean duration of abstinence was 2.9±1.7 days. The mean age of female patients was 38.2±4.0. Higher ejaculatory abstinence period was associated with a higher sperm concentration (Spearman p = 3.1x10–6) but not with a higher total sperm progressive motility. Even so, no significant correlation with EA were observed when considering fertilization rate, blastulation rate, ongoing pregnancy and live birth rate per transfer in analyzed cycles. Triploid zygote rate was positively associated with a higher ejaculatory abstinence period. For the ejaculatory abstinence period of 1 day (n = 64), 2 days (n = 1523), 3 days (n = 1032), 4 days (n = 408), 5 days (n = 174), 6 days (n = 47) and ≥7 days (n = 105) the mean triploid rate was 2.4%, 2.4%, 2.5%, 4.1%, 3.6%, 5.4% and 4.3%, respectively (Spearman p = 9x10–3). Triploid zygote rate was independent of semen volume, concentration and total progressive motility. Limitations, reasons for caution This is a large observational study with a retrospective data collection. Despite our methodological approach, the presence of biases related to retrospective design can not be excluded and it may be a reason for caution. Wider implications of the findings: Our results demonstrate that ejaculatory abstinence period do not affect blastulation, ongoing pregnancy and live birth rates. The current findings discourage an abstinence time longer than 3 days due to its association with a higher abnormal fertilization rate. Trial registration number Not applicable

Ejaculatory abstinence in semen analysis: does it make any sense?

Background: The precise effect of ejaculatory abstinence on semen parameters is highly debatable, especially among subfertile men. Previous studies on effect of abstinence time on different semen parameters have reported controversial results. The aim of this study was to retrospectively assess the variance of semen parameters with different periods of ejaculatory abstinence among both a population of normozoospermic ( n = 1621) and oligozoospermic ( n = 416) Tamil men, presenting to a fertility clinic for an infertility evaluation ( N = 2037). Materials and Methods: A retrospective analysis of 2037 semen analysis reports involved grouping patients based on their ejaculatory abstinence, that is, <24 h, 1 to 2 days, 3 to 7 days, 8 to 15 days, 16 to 30 days, and >30 days. All semen parameters were assessed as per the World Health Organization (WHO, 2010) recommended guidelines. The unpaired two-tailed t-test and Welch’s analysis of variance (ANOVA) combined with Games–Howell post hoc test were used for statistical analysis. A p value <0.05 was considered to be statistically significant. Result: A retrospective analysis of data ( N = 2037) identified no statistically significant differences in semen parameters of sperm concentration, percentage of progressively motile sperm, and normal sperm morphology in both normozoospermic and oligozoospermic individuals across different groups of abstinence. Semen volume was the only parameter that showed a statistically significant difference in both groups ( p < 0.0001). In both normozoospermic and oligozoospermic men, the group with <24 h abstinence had the highest mean percentage of progressively motile sperm and normal sperm morphology. Conclusion: The findings of this study suggest that ejaculatory abstinence may be highly arbitrary, and the recommendation of a strict 2- to 7-day abstinence per the WHO may be liberalized. In both normozoospermic and oligozoospermic men, semen parameters associated with an abstinence of <24 h were found to be noninferior as compared to longer ejaculatory abstinence intervals. These findings support in eliminating conservative recommendations as far as abstinence is concerned and suggest that patients may be asked to collect a semen sample on the day they present for an infertility evaluation, regardless of abstinence.

Improved sperm motility after 4 h of ejaculatory abstinence: role of accessory sex gland secretions

Various studies have sought to determine the typical v. optimal abstinence period after which semen samples should be collected, with many contradictory results reported. Several factors influence the semen microenvironment, and thus sperm parameters. In this study we focused on the secretions of the prostate, seminal vesicles and the epididymis. Semen samples were obtained from healthy normozoospermic males (n=16) after 4-day and 4-h periods of ejaculatory abstinence, and standard semen analysis was performed using computer-aided sperm analysis, whereas seminal plasma citric acid, neutral α-glucosidase and fructose concentrations were measured using assay kits. There were significant decreases in total sperm count (P&lt;0.001), sperm concentration (P&lt;0.05) and semen volume (P&lt;0.05) after 4h compared with 4 days ejaculatory abstinence. Furthermore, increases were observed in total sperm motility (P&lt;0.05) and sperm progressive motility (P&lt;0.01) after a 4-h abstinence period, accompanied by significant reductions in citric acid (P&lt;0.05), α-glucosidase (P&lt;0.01) and fructose (P&lt;0.01) concentrations. In addition, due to the decreased number of spermatozoa, these concentrations translated to a significant decrease in fructose (P&lt;0.05) per spermatozoon, indicating an intrinsic mechanism capitalising on alternative sources of energy for increased metabolic function and subsequent sperm motility.