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

Abstract

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.

Effects of Clomiphene Citrate Versus Letrozole on Semen Count and Motility in Men with Oligoasthenozoospermia in Osogbo, South- Western Nigeria: A Randomised Study

“…There was no significant difference between the sociodemographic characteristics between the participants in both the clomiphene citrate and the letrozole arm of the study, with majority of the participants having infertility for less than 5 years. In other words, the 2 drugs resulted in significant improvement in both sperm count and motility, however, the improvement observed from letrozole group appeared to be more pronounced and the difference was statistically significant [18].…”

“…Written consent was obtained from each participant after explaining the purpose and objective of the study to them and confidentiality was maintained.All principles governing ethical conduct was taken into consideration. The principles of benevolence and non-maleficence were also adopted in dealing with the participants.An increase in semen count of 25% above the highest count before the intervention was regarded as significant improvement while an increase of 10% in motility above the highest value before the intervention will be regarded as significant improvement [18].…”

In vitro maturation of human oocytes maintaining good development potential for rescue intracytoplasmic sperm injection with fresh sperm

“…On the other hand, the shortened time of abstinence could also improve semen quality and significantly reduce the DNA fragmentation rate. Most studies have demonstrated that a long period of abstinence may lead to lower normal morphology and DNA quality rates of sperm, while increased DNA fragmentation can reduce the rate of top embryos, induce embryo development arrest, and even lead to abortion[ 17 , 18 ]. Since the sperm to be used for ICSI are selected randomly, in patients with an increased DNA fragmentation rate, the possibility of selecting sperm with DNA breakage is also increased.…”

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

“…While the World Health Organization (WHO) currently recommends a 2- to 7-day abstinence period prior to a semen analysis [ 75 ], this interval is based largely on the need to standardize semen analysis results rather than on clinical outcomes [ 76 ]. This has prompted researchers to further investigate the optimal abstinence period for infertile men, including its relationship to sperm DNA fragmentation and impact on pregnancy and live birth rates.…”