Does abstinence make the sperm go faster?

Dear Dr G,

I am a father of a beautiful daughter who is now five years old and hoping for a boy next.

My wife and I have been trying for several years but our attempts have not been fruitful.

My 35-year-old wife went for a gynaecological examination and found that her reproductive system is perfectly healthy.

However, we were informed of a possible secondary infertility and I was asked to abstain from sex between two and seven days to produce some semen for analysis.

This revealed that I have poor quality sperm.

I am somewhat surprised as our previous attempts “hit the jackpot” straight away.

Admittedly, I am not healthy after the Covid-19 pandemic.

I have started smoking and put on weight since the MCO – however, I have difficulty believing this can have such an impact on male fertility.

Can you tell me why this is happening? Is it common for male fertility to decline to such an extent?

Why am I being asked to abstain? Does that mean the longer I “hold off”, the better the quality?

Is there any study that proves this?

Thanking you

Abstinent Adam

Infertility is a common condition in modern society and can affect up to 15% of couples, according to the World Health Organisation (WHO).

The prevalence of infertility is likely to increase with urbanisation and attempts for pregnancy older in age due to deferred child-bearing.

Primary infertility can affect couples from the first attempt but couples who have previously been successful and fail in later years are known to have secondary infertility.

The strange thing about fertility is that one would assume having the first baby would guarantee success in subsequent tries. However, one in seven couples encounter secondary infertility, which is more prevalent than primary fertility. For idiopathic infertility, having a normal gynaecological check-up and semen parameters are also not a guarantee for pregnancy.

Declining male fertility has become a main topic worldwide in recent times. Admittedly, most causes of infertility tend to be female-related, but male-factor infertility is known to affect up to 40% of all causes.

The actual causes of declining sperm count are shrouded with uncertainty. In a study, Dr E. Carlsen and other co-workers revealed that sperm counts had halved between 1938 and 1990. This was also backed up by another French investigation of 26,000 semen samples in the fertility clinic between 1989 and 2005. The study demonstrated average sperm count had fallen by one third over 17 years to the low level of 50 million/ml.

The recommended duration of abstinence before sperm analysis is between two to seven days. For men with a normal sperm count, semen volume and sperm concentration are noted to improve after two days of abstinence. However the motility and morphology are demonstrated to decrease after two days of no ejaculation. The quality continues to be affected seven to 10 days after abstinence. Additionally, the genetic health of the sperm suffers with longer abstinence with DNA fragmentation and mitochondrial damages after prolonged abstinence.

In another study with 9,400 semen samples analysed from more than 6,000 men with compromised sperm quality, the peak sperm motility was reached after one day of non-ejaculation. Another study of 576 men who ejaculated twice a day revealed multiple ejaculations per day may even improve the quality.

Although men with low sperm count had no significant difference in the total number of sperm produced in the second attempt, the pooled number noted an increase in the chances of pregnancy. Another study in 2016 with similar results reported better sperm motility with the second ejaculation, which is more successful using the in vitro fertilisation technique.

In truth, the mystery of male primary and secondary infertility is puzzling, to say the least. Thus, the cloud of uncertainty over the reasons behind falling sperm counts remain.