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Docs Suggest Way to Boost Sperm Quality for ART

Men undergoing assisted reproduction with low sperm counts may be able to give them a temporary boost, doctors in a new study propose.1 How? Through sexual abstinence, but only for one day, the study authors emphasize. Abstaining for longer periods may create the opposite effect—reducing the numbers of sperm.

"The duration of sexual abstinence before fertility treatments that is needed to provide maximum sperm quality is one of the issues commonly discussed between physicians and patients," write Eliahu Levitas, MD, in the IVF unit at Soroka University Medical Center in Beer-Sheva, Israel, and his colleagues, in the journal Fertility and Sterility. "Whichever fertility treatment is intended, sperm quality is of paramount importance."

The aim of this study, therefore, was to evaluate the duration of abstinence on the quality of sperm afterwards, the scientists reported. Most fertility clinics likely follow World Health Organization guidelines that recommend abstaining for between 2 to 7 days before semen collection in infertility evaluations, the research team stated.

Sampling Sperm Health
There are various methods of semen analysis. A sample may be obtained through masturbation into a sterile container. Or some patients may supply a sample through intercourse using a special condom provided by the physician. Samples must be analyzed within 2 hours of collection to ensure the accuracy of the results. The semen is analyzed for the number, volume, movement, and structure of the sperm contained in it. Fluid thickness, acidity, and its sugar content are also analyzed. If the sperm count is very low or very high, the odds of being infertile increase. Likewise, the percent of normal sperm has an effect on a man's fertility, as well as the acidity of the semen and the presence of white blood cells that may point to an infection.2

Effect of Abstinence
For their study, Levitas and his colleagues analyzed information gathered from a database on more than 9,400 semen samples collected between 1995 and 2003 from approximately 6,000 patients.

Each sample was then divided into groups pertaining to the length of abstinence that corresponded. Groups ranged from less than 1 day to 11-14 days of abstinence. Sperm analysis was broken down by category: sperm count, sperm motility (movement ability), total motile sperm count, and sperm morphology (normal appearance). These were compared to the days of abstinence noted.

There were 3,506 samples that had low sperm count. While the average semen volume increased gradually relative to the numbers of days of abstinence, the researchers also found that sperm concentration peaked after one day of abstinence, then fell through the fifth day of abstinence. Sperm motility also peaked after one day of abstinence, declining thereafter. The average numbers of sperm with normal morphology also peaked from between 1 and 2 days of abstinence, then fell.

In contrast, men with normal sperm counts had slight decreases in sperm concentration over 2 days of abstinence, followed by increases through abstinence day 6. Unlike those with low sperm counts, sperm motility was high until the seventh day of abstinence in those with normal counts. Sperm morphology remained high in the group of men with normal counts, regardless of whether they abstained or not.

"Avoiding sexual abstinence or abstinence lasting just 1 day [for those with low counts] was related to peak sperm quality," the research group concluded. In those with normal counts, healthy sperm was observed from days 7 to 10 of abstinence. "It should be emphasized that the percentage of normal sperm morphology is positively related to the oocyte [egg] fertilization rates in an IVF setting," they wrote.

Why the Differences?
Why was sperm quality and concentration increased in men with normal sperm counts in this study compared to those with low counts? Levitas and his team theorize that the time it takes sperm to travel through the epididymis—the tube that houses and transports sperm in the testes—is longer in men with low sperm counts. Additionally, other studies have suggested that certain disorders, such as a partial blockage in the testes, may be the causing the low counts.

Sperm may have also been damaged by oxidation caused by free radicals, harmful molecules in the body, the researchers speculated.

Shorter Abstinence Advised
Based on their findings, they recommend that doctors collect semen samples after just 1 day of abstinence with the aim of preserving the highest quality sperm. "The total sperm counts and total motile sperm counts may increase with prolonged sexual self-restraint, but abstinence beyond 4 days should not be recommended so as to contain the deterioration in sperm morphology related to a prolonged abstinence period," they wrote.

Men with normal sperm counts could improve their odds of success in ART by abstaining for up to 10 days. "However, more than 10 days of sexual abstinence should not be recommended; beyond this time frame, the fertility potential may be undermined," the study team advised.

1. Levitas E, Lunenfeld E, Weiss N et al. Relationship between the duration of sexual abstinence and semen quality: analysis of 9,489 semen samples. Fertil Steril 2005 Jun;83(6):1680-6.
2. National Library of Medicine. National Institutes of Health (NIH). Semen Analysis.

John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include overseeing health news coverage for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.

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