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.
Highlights
IntroductionA proper diagnostic and therapeutic workup associated with adequate preparation of infertile couples before assisted reproductive technologies (ART) is essential to obtain spermatozoa and oocytes of high quality and, in turn, to improve the outcomes of ART
We previously reported that a second consecutive ejaculate resulted in better conventional sperm parameters and a lower percentage of spermatozoa with fragmented DNA in normozoospermic male partners of infertile couples and even more in patients with OAT [16]
No statistically significant difference was found between antral follicle count (AFC) of women in Groups 1 and 2
Summary
A proper diagnostic and therapeutic workup associated with adequate preparation of infertile couples before ART is essential to obtain spermatozoa and oocytes of high quality and, in turn, to improve the outcomes of ART. Impairment of sperm parameters may affect fertilization and cleavage rates and the quality of embryos [5]. It can be associated with higher aneuploidy [6] and miscarriage rates [7]. Several antioxidants are commonly used to improve male fertility before ART. Oral antioxidant treatment appears to improve ICSI outcomes, especially in patients with sperm DNA damage, in whom antioxidants reduce the percentage of damaged spermatozoa [8]. A correct diagnostic and therapeutic management of infertile patients before ART is essential to increase success rates, without leaving
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