Role of daily ejaculation for four consecutive days in improving sperm DNA fragmentation index

Abstract

Introduction: Semen analysis is the gold standard for determining male partner fertility but it does not provide any information about the genetic make-up of the sperm, which is essential for normal embryo development. High sperm DNA fragmentation is also found in men with normal semen parameters. Sperm with high DNA damage leads to nuclear instability in the embryo, resulting in developmental arrest, implantation failure, higher miscarriage rate, genetic mutations causing abnormalities in the offspring and increased susceptibility to childhood cancers. European Society for Human Reproduction and Embryology (ESHRE 2017) guidelines recommend sperm DNA fragmentation testing for men whose partners experience recurrent pregnancy loss. In 25th annual meeting of ESHRE it was discussed that daily sex helps to reduce sperm DNA damage and improve fertility. The basis for this is that daily ejaculations reduce the exposure of sperms to reactive oxygen species in testicular ducts and epididymis; hence less DNA damage and improvement in DNA fragmentation index. Extrapolating this, it is hypothesized that a reduction in DFI will be observed when analysing semen obtained after daily ejaculation for four days. Aim: The aim of the study is to evaluate the role of daily ejaculation for four consecutive days in improving the sperm DNA fragmentation index (DFI). Materials and Methods: Out of 170 semen samples, 65 patients had DFI of > 30% in a routine workup of male factor in an infertile couple and were recruited. Of these 56 opted for participating in this study. The initial semen sample was collected after an abstinence of 2-3 days. These patients were then asked to ejaculate daily for four consecutive days. During this period, no medication or any lifestyle modification was advised to these patients. Repeat semen sample was then collected on fifth day and DNA fragmentation index was calculated using the sperm chromatin dispersion (SCD) test. Results: The mean age of the patients was 35.52 years (range 29–50 years). The Indications for raised DFI were: age > 35 years (41%), BMI >25 (30.35%), defective spermatogenesis (31%), diabetes (5.35%), varicocoele (5.35%), smoking (32.14%). The mean DFI in the initial sample was 57.36 ± 17.54 and the mean DFI in the repeat sample was 32.33 ± 21.62. The reduction in the DFI was statistically significant with a P-value of