Influence of sexual abstinence length on sperm parameters and on IVF outcomes in ICSI assisted treatment cycles

Abstract

There is no consensus in the literature for the optimal period of sexual abstinence required for patients undergoing assisted reproduction treatment (ART). Most IVF Clinics suggest a 3–5 days of abstinence. The aim of this study was to evaluate the influence of sexual abstinence on sperm parameters; fertilization; embryo quality and pregnancy rate on ICSI based ART. Retrospective analyses of 445 ICSI cycles. Sexual abstinence was recorded for patients with non-male factor infertiity on the day of oocyte collection. Semen samples were evaluated from all patients at least twice; first: 3 month before treatment and second on the day of ICSI using the WHO criteria. Groups of patients were divided according to the days of sexual abstinence: G1, G2, G3, G4, G5, G6 and G7 (1, 2, 3, 4, 5, 6–10 and ≥11 or more days of abstinence, respectively). Ovarian stimulation was performed by long protocol using Lupron and recombinant FSH. HCG was administered when at least 3 follicles reached 19 mm diameter. Collected oocytes were decumulated and all M2 eggs were injected. Fertilization and embryo development were assessed 20 h, 44 h and 68 h after insemination. Embryo transfer was performed on day 3. Pregnancy was recorded if two rising HCG values were measured; clinical pregnancy was determined by recording FCA. Statistical analyses was performed using the Chi-square test and the One-way ANOVA test; significance was established at P<0.05. Sperm concentration was lower in G1 and higher in G5 and G6 (18.9×106/mL, 27.4×106/mL and 26.3×106/mL respectively (P=0.02). There was no significant difference in sperm motility between the groups (P=0.757). Fertilization rate was higher in groups 1, 3, 5 and 6 (87%, 88%, 88% and 87%, respectively). The lowest fertilization rate was in G7 (81%). The best embryo quality was found in G1. The highest pregnancy rate was also observed in G1 (67.2%) while the lowest, in G5 (42.1%). The difference in pregnancy rate between G1 and G5, G6 and G7 showed to be significant (P=0.007). Shorter abstinence period is associated with lower sperm concentration higher embryo quality and higher pregnancy rate. Conversely, five or more days of abstinence was correlated with a considerable decrease in pregnancy rate. These findings suggest that there is an inverse correlation with the time of sexual abstinence and ICSI results. Hence, a short period of sexual abstinence is suggested whenever ICSI is performed.