Short ejaculatory abstinence in normozoospermic men is associated with higher clinical pregnancy rates in sub-fertile couples undergoing intra-cytoplasmic sperm injection in assisted reproductive technology: A retrospective analysis of 1691 cycles

Abstract

Background: The current WHO abstinence recommendations are ideal only for clinical diagnosis, as in recent years a negative correlation of abstinence duration with good embryo development and clinical pregnancy rate has been seen. Aim: The aim of the study was to evaluate the impact of variation in abstinence period on fertilization, embryo development potential, pregnancy, and miscarriage rate in sub-fertile couples undergoing assisted reproductive technology (ART) treatment. Setting and Design: A prospective analysis was conducted at a tertiary (level 3) infertility care clinic. Materials and Methods: The study included analysis of 1691 cycles for the patient undergoing ART procedures between September 2017 and August 2019. The influence of ejaculatory abstinence (EA) was investigated based on variation in abstinence length with four groups: Group I – 1 day; Group II – 2–5 days; Group III – 6–7 days; and Group IV – EA length of ≥8 days. Statistical Analysis: Analysis of variance and Chi-square test were used to calculate P value. Results: In our primary outcome, we have seen a strong positive correlation of abstinence duration with semen volume, total sperm count, total motile count, and difference between each group was significant. Secondary outcomes showed a significantly higher implantation rate, biochemical pregnancy rate was observed in Group I (1 day) per embryo transfer as compared to longer abstinence groups. This resulted in significantly higher clinical pregnancy rates in Group I 30.0% vs. 25.4% in comparison to longer abstinence groups. Conclusions: Our study has shown duration of abstinence is negatively correlated with positive β-human chorionic gonadotropin rate, clinical pregnancy rate, and implantation rate. Lower miscarriage rate was also observed with shorter abstinence duration.

Lifestyle-, environmental-, and additional health factors associated with an increased sperm DNA fragmentation: a systematic review and meta-analysis

“…Several risk factors show a dose-dependency in our study, such as smoking, alcohol consumption, and BMI. Contrary to our expectations, based on the recommended, but not evidence-based short ejaculatory abstinence protocol supported by Gupta et al based on standard semen parameters, different abstinence periods did not seem to alter SDF in our study significantly [ 26 , 27 ]. Also, the effect of paternal age manifests later than expected based on the article by Matorras et al at 35–39 years, which is above 50 according to our study [ 28 ].…”

The Influence of Male Ejaculatory Abstinence Time on Pregnancy Rate, Live Birth Rate and DNA Fragmentation: A Systematic Review

“…Three of the studies with low quality had study populations under 11 [ 20 , 30 , 31 ], which increases the risk of Type II error due to low power and thus weakens the strength of evidence. Eight studies had large populations ( n ≥ 800), of which six were retrospective and can according to the SIGN methodology checklist only maximally be rated as acceptable; however, three of these were of high quality in all other domains [ 36 , 38 , 40 ]. Six studies were downgraded from high quality to acceptable quality due to missing confidence intervals.…”

“… Pregnancy rates and ejaculatory abstinence time of 13 included studies reporting pregnancy rate. Solid line: statistically significant difference ( p < 0.05), dotted line: no statistically significant difference ( p > 0.05), EA: ejaculatory abstinence time [ 19 , 21 , 25 , 26 , 27 , 29 , 33 , 34 , 35 , 36 , 38 , 40 , 41 ]. …”

“…In the present review, most of the included studies reporting pregnancy rates found the highest rates with EAs of less than four days. Five studies showed significantly higher pregnancy rates with EA as short as one day or less when compared to longer abstinence times; for example, Gupta et al [ 36 ] analyzed a large sample of 1691 cycles and found significantly higher pregnancy rates with one day of EA compared to 2–5, 6–7 and >8 days.…”

“… 1.5 = NA retrospective 1.10 = Yes 2.2 = Yes 1.6 = NA 1.11 = Yes 2.3 = Yes Barbagallo et al [ 34 ] 1.1 = Ýes 1.2 = Can’t say 1.7 = Yes 1.13 = Yes 1.14 = No 2.1 = Acceptable 1.5 = Not reported 1.10 = Yes 2.2 = Yes 1.6 = NA 1.11 = Yes 2.3 = Yes Kably-Ambe et al [ 35 ] 1.1 = Yes 1.2 = Yes 1.7 = Yes 1.13 = Can’t say 1.14 = No 2.1 = Acceptable Retrospective design. 1.5 = NA retrospective 1.10 = Yes 2.2 = Yes 1.6 = NA 1.11 = Yes 2.3 = Yes Gupta et al [ 36 ] 1.1 = Yes 1.2 = Yes 1.7 = Yes 1.13 = Yes 1.14 = Yes 2.1 = Acceptable High quality study but cannot rate higher than acceptable because of retrospective study design. 1.5 = NA retrospective ...…”