Does a Very Short Length of Abstinence Improve Assisted Reproductive Technique Outcomes in Infertile Patients with Severe Oligo-Asthenozoospermia?

Abstract

In recent years, a growing number of studies seem to support the beneficial effects of a very short abstinence period on sperm parameters, especially in patients with oligo-asthenozoospermia (OA). On this basis, the aim of this study was to evaluate the effects of a short period of abstinence (1 h) on intracytoplasmic sperm injection (ICSI) outcomes in infertile patients with severe OA. We performed a retrospective study on 313 ICSI cycles in which couples were divided into two different groups based on sperm parameters of the male partners. Group 1 included normozoospermic men or male partners with a mild OA (n = 223). Group 2 included male partners with severe OA (n = 90). They were asked to provide a second consecutive ejaculation after 1 h from the first one. The best ejaculate was used to perform ICSI. We found a significant increase of total (p < 0.001) and progressive motility (p < 0.001) in the second ejaculate of patients of Group 2 compared with those of the first one. Spermatozoa of the second ejaculate were chosen for ICSI for all patients in Group 2. We found statistically significant improvement of clinical pregnancy rate (p = 0.001) and embryo quality (p = 0.003) in couples in Group 2 compared to those of Group 1. No statistically significant difference was found in fertilization, implantation, live birth delivery, and miscarriage rates between the two groups. Therefore, a second semen sample collected after a very short time-interval in patients with severe OA allowed us to obtain significantly higher clinical pregnancy rate with improved embryo quality compared to normozoospermic men or patients with mild OA. Fertilization, implantation, live birth delivery, and miscarriage rates were similar between the two groups. The present study shows that a second consecutive ejaculate could represent a simple strategy to obtain better sperm parameters and assisted reproductive technology (ART) outcomes in infertile patients with mild-severe OA.

Optimizing outcomes for men with severe infertility

“…Specifically, most studies suggest that a very short ejaculatory abstinence interval improves sperm motility and ART outcomes for infertile men – with some series demonstrating higher pregnancy rates than normospermic controls adhering to a standard abstinence interval [16 ▪ ]. Although these results have not yet been validated in larger, prospective series, and there may be logistical challenges associated with having infertile men provide multiple ejaculated samples prior to ICSI, this represents a noninvasive way to potentially have a positive impact on the reproductive outcomes of infertile couples.…”

“…The same group published another study in 2021 evaluating the effect of this very short (1 h) abstinence interval on ICSI outcomes for oligoasthenospermic (OA) men [16 ▪ ]. In this retrospective review of 313 ICSI cycles, the authors compared men with normal semen parameters or mild OA (Group 1, n = 233) to men with severe OA (Group 2, n = 90).…”

Sperm DNA Damage and Its Relevance in Fertility Treatment: A Review of Recent Literature and Current Practice Guidelines

“…The first study by Barbagallo et al evaluated the effect of a 1 h abstinence interval on ICSI outcomes for oligoasthenospermic (OA) men [ 87 ]. In this retrospective review of 313 ICSI cycles, the authors compared men with normal semen parameters or mild OA (Group 1, n = 233) to men with severe OA (Group 2, n = 90).…”

“…While all men provided a fresh semen sample for ICSI after a standard abstinence interval of 2 to 7 days, only men with severe OA (Group 2) provided a second semen sample after 1 h of abstinence. For these men, the second sample demonstrated better total motility ( p < 0.0001) and progressive motility ( p < 0.0001) compared to the initial sample [ 87 ]. Unfortunately, sperm DNA fragmentation was not measured.…”

Assisted Reproductive Technology without Embryo Discarding or Freezing in Women ≥40 Years: A 5-Year Retrospective Study at a Single Center in Italy

“…We evaluated 400 spermatozoa per replicate for an accurate assessment of motility. We asked male partners with severe oligoasthenozoospermia (OA) to provide a second consecutive ejaculation 1 h after the first, after explaining the possibility of having better sperm parameters in the second ejaculate [ 45 , 46 ].…”