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The impact of ejaculatory abstinence on semen parameters using in-office semen analyses has been well-established; however, their variability has not been evaluated in men using mail-in semen analysis kits. Our study aims to describe how the sperm parameters using mail-in semen analysis tests change with abstinence and validate their equivalence to those seen with in-office semen analysis tests. We retrospectively reviewed the semen analysis results of men using mail-in semen analysis tests provided by Give Legacy, Inc (Legacy) facilities from 2019 to 2021. We collected their demographic information, abstinence duration, and semen parameters (conventional and kinematic) from their records. Semen samples were categorized as normozoospermic and oligozoospermic based on concentration. The shape of the relationship between abstinence duration and semen parameters was assessed via generalized additive models. We have collected 3,469 unique samples provided by 2,609 (75%) normozoospermic men and 860 (25%) oligozoospermic from all over the United States. In normozoospermic men, longer periods of sexual abstinence were linked to higher levels of sperm concentration, total sperm count, and total motile sperm. However, there was a decline in both total and progressive motility. Conversely, in oligozoospermic men, extended periods of abstinence led to a rapid decline in total motile sperm, as well as total and progressive motility. There was no significant correlation observed between sexual abstinence and variations in sperm morphology. Our study shows that variability of sperm parameters with abstinence, as measured through mail-in semen analysis tests, is comparable to the patterns observed with conventional in-office sperm testing.

Introduction: The connection between abstinence times and semen round cells and pyospermia is not well understood. However, frequent ejaculation is a commonly prescribed treatment for pyospermia. Objective: We sought to identify if a correlation exists between abstinence periods and round cells and semen leukocytes. Methods: We conducted a retrospective review of men presenting to a high-volume fertility center for evaluation who had semen samples assessed for leukocytes between 2/1/2022 and 1/1/2023. Azoospermic men and men with abstinence times over 14 days were excluded. We recorded round cells, the presence of leukocytes, and days of abstinence prior to the sample. The presence of leukocytes was detected using test strips which report a positive result if the concentration of leukocytes was greater or equal to 1 million/ml. The study received IRB approval. Pearson correlations (assumes linear relationship) were used as well as generalized additive models (GAMs), which allow for a non-linear relationship between abstinence and the outcome. For analysis of semen leukocytes, a positive result was coded as 1 and a negative result was coded as 0. Round cells were log-transformed prior to calculating correlation. The estimated relationships from GAMs were plotted graphically and summarized via average marginal slopes. Results: A total of 382 semen analyses were included, with a mean abstinence period of 3.67 days (SD: 2.11). The number of round cells ranged from 0.2 to 44.0 million (mean: 4.21 million, SD: 4.68), with 19.1% (n = 73) of samples testing positive for leukocytes. Days of abstinence and round cells are significantly correlated according to a Pearson correlation (r = 0.14, p = 0.006). According to the GAM, with each day increase in abstinence, a 0.52 million increase in round cells is expected (CI 0.25-0.79 million; p<0.05). There is an increase in round cells from 0 to 5 days of abstinence before plateauing. Beyond 10 days there is a large degree of uncertainty, due to a low number of observations. When patients with negative pyospermia tests were excluded, there is no linear correlation (r = 0.11, p = 0.36), however, the GAM appears similar to the original sample (1.2; 0.2, 2.1; p<0.05). Semen leukocytes and abstinence are not significantly correlated according to the Pearson correlation (r = -0.04, p = 0.38). There is little change in the probability of leukocytes being present with respect to abstinence in the GAM (-0.001; CI 2.3-2.1; p = 0.926). There is a similar increase in the degree of uncertainty over 10 days. Conclusions: These results demonstrate a statistically significant, yet very minimal linear correlation between round cells and days of abstinence. There is an increasing number of round cells up to 5 days of abstinence before plateauing. However, there was no significant correlation between abstinence time and the presence of leukocytes in the semen in either model. Shorter abstinence times may have a role in reducing semen round cells, but it is unlikely to reduce pyospermia. Providers should be hesitant when suggesting an increased frequency of ejaculation to treat pyospermia. Disclosure: No. [ABSTRACT FROM AUTHOR]