^{Abstinence Instructions: The Waiting Game}

^{By Mr Stuart Dawe-Long BSc PGCert MSc CSci FIBMS}

^{Andrology Lead Scientist, Department of Reproductive Medicine, Manchester University NHS Foundation Trust.}

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‍For semen analysis, the WHO 6th Edition guidelines recommend an abstinence period of 2–7 days.

This range is accepted for diagnostic testing, but it can also introduce variation in results. Understanding why abstinence matters, and how it affects sperm parameters, can help patients navigate testing with more confidence.

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Understanding the WHO Guidance

The World Health Organisation (WHO) 6th Edition guidelines on the examination and processing of human semen (1) state that the abstinence period for semen analysis should be a minimum of 2 days and a maximum of 7 days.

Although this range is broad, WHO acknowledges that it can lead to differences in semen results and may complicate interpretation, particularly when distinguishing between normal and sub-fertile samples.

Most accredited diagnostic services follow the 2–7 day requirement, meaning any sample produced within this window is acceptable.

It is important to note that sperm numbers vary naturally, even when the abstinence period is the same for the same man over time.

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Does Longer Abstinence Improve Sperm Count?

Many people believe abstaining for longer than 7 days will increase sperm count. This is not advised.

Couples trying to conceive should aim for regular unprotected sexual intercourse, two to three times per week (2). This helps natural fertility and avoids unnecessary sperm ageing.

Services should also recognise that producing a sample cannot always be timed perfectly. Diagnostic teams should be flexible and supportive, including offering home sample collection where appropriate.

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Short Abstinence Periods and DNA Quality

Some studies have suggested that short abstinence periods (less than 2 days) may reduce sperm DNA damage and improve pregnancy outcomes (3). However, a shorter abstinence period may also lead to samples that appear below WHO reference limits for sperm count.

WHO guidelines (1) reference evidence indicating that abstinence does not significantly impact sperm vitality or chromatin.

There is, however, a known risk associated with reactive oxygen species (ROS). When sperm remain stored in the epididymis for extended periods, oxidative stress may contribute to DNA damage (4).

Units offering DNA fragmentation testing should base their abstinence recommendations on the specific test used, as different techniques measure different aspects of DNA integrity. Services must rely on their validated internal evidence, which will vary between clinics. Always follow the advice given by the testing unit to ensure you receive accurate information and guidance.

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Why There Is No Single “Correct” Abstinence Period

A universal recommendation for abstinence simply does not exist.

The optimal duration depends on:

• the reason for testing
• clinical history
• test type
• laboratory methodology
• individual variation

This lack of definitive guidance can feel frustrating for couples undergoing fertility investigations. Asking “why?” and seeking clarification is encouraged. Understanding the rationale behind recommendations empowers patients and helps them feel more in control during a challenging process.

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Glossary of Useful Terms

Abstinence period

The number of days you do not ejaculate (no sex, no masturbation, no wet dreams).

DNA

Your genetic code. In sperm, we are interested in DNA fragmentation—whether the DNA is damaged.

Vitality

Indicates the percentage of living sperm in a sample.

Chromatin

The structure in which DNA is packaged within the sperm head.

Reactive Oxygen Species (ROS)

Small, reactive molecules. A normal amount is healthy, but too much can cause cellular damage.

Oxidative stress

Occurs when there are too many ROS and not enough antioxidants. This imbalance can damage sperm membranes, DNA, and overall sperm quality.

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References

1. World Health Organisation. WHO laboratory manual for the examination and processing of human semen [Internet]. www.who.int. 2021. Available from: https://www.who.int/publications/i/item/9789240030787
2. Trying for a baby. Information for the public, Fertility problems: assessment and treatment, Guidance, NICE [Internet]. www.nice.org.uk. Available from: https://www.nice.org.uk/guidance/cg156/ifp/chapter/Trying-for-a-baby
3. Sørensen F, Melsen LM, Fedder J, Soltanizadeh S. The Influence of Male Ejaculatory Abstinence Time on Pregnancy Rate, Live Birth Rate and DNA Fragmentation: A Systematic Review. Journal of Clinical Medicine. 2023 Mar 13;12(6):2219.
4. Lewis SEM, Agbaje I, Alvarez J. Sperm DNA Tests as Useful Adjuncts to Semen Analysis. Systems Biology in Reproductive Medicine. 2008 Jan;54(3):111–25.

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