Semen analysis: The effects of short waiting periods

Medically assisted reproduction includes, amongst other things, IVF and ICSI. In in vitro fertilisation, or IVF for short, retrieved eggs are fertilised with sperm outside the body. The treatment team will determine which method is suitable for a couple as part of the assisted reproduction process.

ICSI stands for intracytoplasmic sperm injection. In this procedure, a single sperm cell is injected directly into an egg. Whether IVF or ICSI is planned may also influence the guidelines for semen collection.

The treatment team will discuss with the couple which factors are taken into account when making this decision. The instructions provided by the fertility clinic should be followed. The duration of abstinence should not be altered independently on the basis of individual studies.

A semen analysis assesses sperm quality. In the laboratory, at least three key parameters are recorded: sperm count, motility and appearance. The appearance is referred to as morphology.

For a reliable assessment, these three parameters must be considered together. They provide indications of the man’s fertility, but do not, on their own, allow for a definitive diagnosis. Concentration, motility and morphology cannot, on their own, conclusively determine either fertility or infertility.

In addition, volume, pH level and white blood cell count may be measured. Such parameters supplement the assessment of sperm quality, but each reflects only one aspect of it. Even a result that appears normal therefore does not definitively rule out possible causes of infertility.

The abstinence period refers to the time spent without ejaculation prior to providing a semen sample. For a comparable semen analysis, the current guideline recommends abstinence for 2 to 7 days. However, studies from 2025 and 2026 raise the question of why a significantly shorter period of abstinence can alter certain characteristics of the sperm in some men.

DNA fragmentation means that the genetic material of some of the sperm contains breaks. The measured value therefore describes a specific aspect of the quality of the genetic material. In two studies, this proportion was lower in a second sample collected shortly afterwards. However, no definite therapeutic benefit can be inferred from this.

The studies examined different groups and endpoints. This limitation is particularly evident in the preliminary study: it compared the quality of two samples but did not record subsequent pregnancies.

Nor does the larger IVF analysis answer every question regarding the preparation of a diagnostic semen analysis. It examined treatment outcomes for couples who had already undergone IVF. Consequently, its findings cannot be readily applied to every semen analysis or every man.

For men, this may include a semen analysis. Possible causes of reduced sperm quality include undescended testicles in childhood, hormonal imbalances and infections.

1. Medical assessment: Gynaecological or urological practices can arrange initial examinations.
2. Semen analysis: The ejaculate is collected in accordance with the laboratory’s guidelines; a abstinence period of 2 to 7 days is usually required to ensure comparable results.
3. Joint assessment: The semen analysis is evaluated alongside other findings, as individual semen parameters do not allow for a definitive diagnosis.
4. Choice of procedure: The treatment team discusses whether ICSI or another assisted reproductive technology is appropriate.
5. Preparation for IVF: The ovaries are usually stimulated with hormones so that several viable eggs can be retrieved.

The exact preparation depends on the planned treatment and the individual findings. This also applies to the question of how long the man should abstain from ejaculation prior to providing a semen sample. Anyone who already has an appointment should follow the guidelines provided by the laboratory or fertility clinic until the treating doctor recommends otherwise.

Fertility treatment and its course are planned for each couple based on the full set of test results. A single result regarding sperm quality does not determine the course of treatment. Even values that appear normal do not, on their own, explain why pregnancy has not occurred.

The chances of success with IVF cannot be determined solely on the basis of the semen analysis or the abstinence period. Factors such as age, the initial medical situation and the chosen method all play a role. The Joint Federal Committee estimates the success rate of IVF, in terms of the birth of a healthy child, at 25 to 30 per cent. This range does not constitute an individual prognosis.

In the case of artificial insemination carried out in accordance with statutory requirements, the patient’s contribution – including the cost of medication – amounts to 50 per cent of the total costs incurred. Before treatment can begin at the expense of statutory health insurance, a treatment plan must be submitted to the health insurance provider for approval.

Women covered by statutory health insurance are no longer entitled to the artificial insemination benefit set out in the guidelines from the age of 40, and men from the age of 50. Couples should clarify with the fertility clinic and their health insurance provider which costs will remain their responsibility in each individual case before starting treatment.

If a woman does not become pregnant after a year of regular unprotected sexual intercourse, it is advisable to investigate possible fertility problems. Couples can contact a gynaecological or urological practice for this.

The doctor does not assess the semen analysis in isolation. There may be various reasons why pregnancy has not occurred, relating to one or both partners. Medical factors on both sides are therefore taken into account in the joint assessment and help to interpret any abnormal laboratory results.

If treatment is already being arranged, any questions regarding the abstinence period should be clarified directly with the relevant laboratory. The studies do not provide a general basis for shortening the recommended period of abstinence prior to any semen analysis or artificial insemination.