The Impact of a Very Short Abstinence Period on Conventional Sperm Parameters and Sperm DNA Fragmentation: A Systematic Review and Meta-Analysis

Abstract

Purpose: In recent years, a growing number of studies have supported the beneficial effects of a very short abstinence period on sperm parameters, especially in patients with oligoasthenozoospermia. However, the results are controversial and no consensus exists regarding whether to request a second semen collection in clinical practice. Therefore, this systematic review and meta-analysis aimed to evaluate the influence of a very short abstinence period (within 4 h) on conventional sperm parameters and sperm DNA fragmentation (SDF) rate.

Materials and methods: The literature search was performed using Scopus and PubMed databases. The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) guidelines. All eligible studies were selected according to the Population, Intervention, Comparison/Comparator, Outcomes, and Study design (PICOS) model. The quality of evidence of the included studies was analyzed through the Cambridge Quality Checklists. The standardized mean difference (SMD) was used to analyze the outcomes. Cochran-Q and I2 statistics were used to evaluate statistical heterogeneity.

Results: We assessed for eligibility 1334 abstracts, and 19 studies were finally included. All 19 articles evaluated the effects of a very short abstinence period on sperm parameters and, among these, 5 articles also evaluated the effects on SDF rate. The quantitative analysis showed a significant reduction in semen volume after a very short abstinence period in both normozoospermic men and patients with oligozoospermia, asthenozoospermia, and/or teratozoospermia (OAT) patients. We found a statistically significant increase in sperm concentration and total and progressive motility in the second ejaculation of patients with OAT. In contrast, the SDF rate decreased significantly in the second ejaculate of OAT patients.

Conclusions: This is the first systematic review and meta-analysis investigating the impact of a very short abstinence period on sperm parameters and SDF rate. The results suggest that collecting a second consecutive ejaculation after a very short time from the first could represent a simple and useful strategy for obtaining better-quality spermatozoa, especially in patients with abnormal sperm parameters.

Keywords: consecutive ejaculation; couples infertility; ejaculatory abstinence; sexual abstinence period; sperm DNA fragmentation.

Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Figures

Figure 1

Flowchart of studies included.

Figure 2

Forest plot of studies that evaluated the effects of a very short abstinence period on semen volume (expressed in mL). The following studies were included in the quantitative analysis (in order of appearance in the manuscript): Manna et al., 2020 [16], Bahadur et al., 2016 [17], Ortiz et al., 2016 [18], Alipour et al., 2017 [19], Ragheb et al., 2018 [20], Ciotti et al., 2021 [22], Tur-Kaspa et al., 1994 [27], Barash et al., 1995 [28], Bar-Hava et al., 2000 [29], Sugyam et al., 2008 [30], Hussein et al., 2008 [31], Mayorga-Torres et al., 2016 [32], Scarselli et al., 2019 [33], Alipour et al., 2021 [34], Kulkarmi et al., 2022 [36], and Patel et al., 2022 [37].

Figure 3

Forest plot of studies that evaluated the effects of a very short abstinence period on sperm concentration (expressed in mil/mL). The following studies were included in the quantitative analysis (in order of appearance in the manuscript): Manna et al., 2020 [16], Bahadur et al., 2016 [17], Ortiz et al., 2016 [18], Alipour et al., 2017 [19], Ragheb et al., 2018 [20], Ciotti et al., 2021 [22], Tur-Kaspa et al., 1994 [27], Barash et al., 1995 [28], Bar-Hava et al., 2000 [29], Sugyam et al., 2008 [30], Hussein et al., 2008 [31], Mayorga-Torres et al., 2016 [32], Scarselli et al., 2019 [33], Alipour et al., 2021 [34], Barbagallo et al.,2021 [35], and Kulkarmi et al., 2022 [36].

Figure 4

Forest plot of studies that evaluated the effects of a very short abstinence period on total sperm motility (expressed in percentage). The following studies were included in the quantitative analysis (in order of appearance in the manuscript): Manna et al., 2020 [16], Ortiz et al., 2016 [18], Alipour et al., 2017 [19], Ragheb et al., 2018 [20], Ciotti et al., 2021 [22], Tur-Kaspa et al., 1994 [27], Barash et al., 1995 [28], Bar-Hava et al., 2000 [29], Sugyam et al., 2008 [30], Mayorga-Torres et al., 2016 [32], Scarselli et al., 2019 [33], Alipour et al., 2021 [34], Barbagallo et al., 2021 [35], and Kulkarmi et al., 2022 [36].

Figure 5

Forest plot of studies that evaluated the effects of a very short abstinence period on progressive sperm motility (expressed as a percentage). The following studies were included in the quantitative analysis (in order of appearance in the manuscript): Manna et al., 2020 [16], Ortiz et al., 2016 [18], Ragheb et al., 2018 [20], Ciotti et al., 2021 [22], Bar-Hava et al., 2000 [29], Mayorga-Torres et al., 2016 [32], Alipour et al., 2021 [34], Barbagallo et al., 2021 [35], Kulkarmi et al., 2022 [36], and Patel et al., 2022 [37].

Figure 6

Forest plot of studies that evaluated the effects of a very short abstinence period on sperm morphology (expressed as a percentage). The following studies were included in the quantitative analysis (in order of appearance in the manuscript): Manna et al., 2020 [16], Bahadur et al., 2016 [17], Ragheb et al., 2018 [20], Ciotti et al., 2021 [22], Barash et al., 1995 [28], Sarselli et al., 2019 [33], Barbagallo et al., 2021 [35].

Figure 7

Forest plot of studies that evaluated the effects of a very short abstinence period on sperm DNA fragmentation (expressed as a percentage). The following studies were included in the quantitative analysis (in order of appearance in the manuscript): Manna et al., 2020 [16], Hussein et al., 2008 [31], Mayorga-Torres et al., 2016 [32], Kulkarmi et al., 2022 [36].