title: Increased count, motility, and total motile sperm cells collected across three consecutive ejaculations within 24 h of oocyte retrieval: implications for management of men presenting with low numbers of motile sperm for assisted reproduction.
abstract: OBJECTIVE
  The purpose of this study was to quantitate changes in seminal volume, sperm count, motility, qualitative forward progression, and total motile sperm cells per ejaculate, across three consecutive ejaculates collected from individuals within 24 h preceding an IVF cycle.
  
  
  METHODS
  Men presenting with oligoasthenozoospermia or asthenozoospemia attempted three ejaculates within 24 h preceding IVF. Ejaculate 1 was produced the afternoon prior to oocyte retrieval, and ejaculates 2 and 3 were produced the morning of oocyte retrieval with 2-3 h between collections. Ejaculates 1 and 2 were extended 1:1 v/v with room temperature rTYBS. Test tubes were placed into a beaker of room temperature water, then placed at 4 °C for gradual cooling. Ejaculate 3 was not extended, but pooled with ejaculates 1 and 2 and processed for intracytoplasmic sperm injection (ICSI).
  
  
  RESULTS
  Out of 109 oocyte retrievals, 28 men were asked to attempt multiple consecutive ejaculations. Among this population, 25/28 (89.3 %) were successful, and 3/28 men (10.7 %) could only produce two ejaculates. Mean volumes for ejaculates 1, 2, and 3 were significantly different from each other (p < 0.01); the volume decreased for each ejaculate. Mean sperm counts, motility, qualitative forward progression, and total motile cells per ejaculate for the ejaculates1, 2, and 3 demonstrated the following: ejaculates 2 and 3 were not significantly different, but counts, motility, and total motile sperm were improved over ejaculate 1 (p < 0.01).
  
  
  CONCLUSIONS
  Pooling three consecutive ejaculates within 24 h increased the numbers of available motile sperm in this population by 8-fold compared to the first ejaculate alone, facilitating avoidance of sperm cryopreservation and additional centrifugation steps that could affect sperm viability and/or function.
authors.affiliation: Center for Reproductive Medicine of New Mexico, 201 Cedar Street SE, Suite S1-20, Albuquerque, NM, 87106, USA, Alh.said@gmail.com.
authors.forename: Al-Hasen
authors.initials: AH
authors.lastname: Said
authors.forename: Michael L
authors.initials: ML
authors.lastname: Reed
mesh_terms: D000328:Adult; D053627:Asthenozoospermia / Q000473:pathology*; D001755:Blastocyst / Q000166:cytology / Q000502:physiology; D004542:Ejaculation; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D008297:Male; D054315:Oocyte Retrieval; D012189:Retrospective Studies; D013076:Sperm Count; D013081:Sperm Motility; D013094:Spermatozoa / Q000166:cytology* / Q000502:physiology; D016896:Treatment Outcome