Optimizing outcomes for men with severe infertility

Abstract

Purpose of reviewTo evaluate recent evidence related to optimizing outcomes for men with severe infertility, including effect of ejaculatory abstinence interval on semen parameters and assisted reproductive technology (ART) outcomes, and impact of cryopreservation on surgically retrieved testicular sperm obtained from men with nonobstructive azoospermia (also referred to as azoospermia due to spermatogenic dysfunction).Recent findingsRecent evidence strongly suggests that a short abstinence interval improves sperm motility and ART outcomes. Similarly, recent studies have concluded that using fresh vs. frozen testicular sperm results in higher live birth rates.SummaryAlthough the World Health Organization currently recommends a 2- to 7-day ejaculatory abstinence period, this interval is based more on the need to standardize semen parameters than clinical outcomes. In fact, recent evidence suggests that shorter abstinence consistently improves sperm motility and ART outcomes for infertile men. Similarly, recent studies have reported an improvement in live birth rates with fresh (vs. frozen) testicular sperm, though their retrospective design and lack of intention to treat analyses makes it difficult to draw strong conclusions. Although additional, well designed studies are needed, providers may be able to leverage these techniques in their practice to improve outcomes for some infertile men.

The Influence of Lifestyle on Male Fertility in the Context of Insulin Resistance—Identification of Factors That Influence Semen Quality

“…Shorter abstinence significantly improves motility and correlates positively with ART outcomes in couples with infertility issues due to the male factor. Recent research also indicates semen freshness as a possible determinant of a higher number of live births [69]. In contrast, Sauer et al found that the duration of sexual abstinence did not affect sperm motility, but it is worth noting that the maximum duration of sexual abstinence in this study was only 120 h [70].…”

“…In itself, sexual abstinence does not constitute a parameter strictly related to lifestyle; however, it would seem necessary to use the findings discussed above to establish standards in sample collection for fertility tests. Nonetheless, the duration of sexual abstinence appears to have a significant impact on semen quality in men, particularly as far as motility is concerned [69]. This relationship suggests that making clinical decisions based on data from samples collected at an inappropriate time may prove to be incorrect.…”

The Influence of Lifestyle on Male Fertility in the Context of Insulin Resistance – Identification of Factors That Influence Semen Quality with the Construction of a Multivariate Model for the Prediction of Correct or Incorrect Sperm Motility Test Results

“…Shorter abstinence significantly improves motility and correlates positively with ART outcomes in couples with infertility issues due to the male factor. Recent research also indicates semen freshness as a possible determinant of a higher number of live births [41]. Sauer et al found that the duration of sexual abstinence did not affect sperm motility, but it is worth noting that in the studied groups, the maximum duration of sexual abstinence was only 120 hours [42].…”

“…In itself, sexual abstinence is not a parameter strictly related to lifestyle; however, it would seem necessary to use the findings discussed above to establish standards in sample collection for fertility tests. Nonetheless, the duration of sexual abstinence appears to have a significant impact on semen quality in men, particularly motility [41]. This relationship suggests that making clinical decisions based on data from samples collected at an inappropriate time may prove to be incorrect.…”