Optimizing outcomes for men with severe infertility

Purpose of reviewTo evaluate recent evidence related to optimizing outcomes for men with severe infertility, including effect of ejaculatory abstinence interval on semen parameters and assisted reproductive technology (ART) outcomes, and impact of cryopreservation on surgically retrieved testicular sperm obtained from men with nonobstructive azoospermia (also referred to as azoospermia due to spermatogenic dysfunction).Recent findingsRecent evidence strongly suggests that a short abstinence interval improves sperm motility and ART outcomes. Similarly, recent studies have concluded that using fresh vs. frozen testicular sperm results in higher live birth rates.Although the World Health Organization currently recommends a 2- to 7-day ejaculatory abstinence period, this interval is based more on the need to standardize semen parameters than clinical outcomes. In fact, recent evidence suggests that shorter abstinence consistently improves sperm motility and ART outcomes for infertile men. Similarly, recent studies have reported an improvement in live birth rates with fresh (vs. frozen) testicular sperm, though their retrospective design and lack of intention to treat analyses makes it difficult to draw strong conclusions. Although additional, well designed studies are needed, providers may be able to leverage these techniques in their practice to improve outcomes for some infertile men.