July 13, 2003

“Our data challenge the role of abstinence in male infertility treatments,” says Dr. Eliahu Levitas, a senior physician at Soroka’s fertility and IVF unit. Whenever science endorses increased sexual activity, it is generally welcomed as good news. But when the issue is fertility treatments and the results challenge current medical wisdom, it is also important news.

And indeed, new research by Israeli fertility experts has challenged current medical opinion, which holds that refraining from sex for up to a week is beneficial for men prior to undergoing some types of fertility treatment.

Israeli fertility experts who have tested semen samples from 6,000 men counter conventional medical opinion that requires males to abstain from sex for up to a week before giving sperm for their partner’s in vitro fertilization.
Dr. Eliahu Levitas and colleagues from Soroka Hospital and Ben-Gurion University of the Negev in Beersheba presented their findings at the European Society of Human Reproduction and Embryology meetings in Spain late last month.

They examined over 7,200 semen samples for volume, concentration, and shape, and the percentage and total count of motile (active and moving) sperm. The samples were taken from around 6,000 men being investigated or treated for infertility who had abstained from sex for periods up to two weeks.

More than 4,500 samples had normal sperm counts, while the remainder had varying degrees of reduced counts ranging from mild to severe.

The researchers found that while the volume of semen increased after 11 to 14 days of abstinence, whatever the sperm count was, the morphology (shape and form) of the sperm gradually deteriorated. In the samples from men with reduced sperm counts, the proportion of motile sperm actually fell significantly from day two onward, reaching a low at day six and remaining low.

“Our data challenge the role of abstinence in male infertility treatments,” said Levitas, a senior physician at Soroka’s fertility and IVF unit.

He was referring to the World Health Organization guidelines recommending sexual abstinence for two to seven days prior to treatment.

“What we have found is not so relevant to [the procedure in which] only a single sperm is injected into the egg, but for those treatments where we are trying to get the best possible sperm quality for intrauterine insemination,” he added. “For these patients we recommend minimal abstinence – ideally no more than two days.”

Levitas told the conference that there is no real agreement among fertility researchers as to why sperm gets damaged and becomes less viable over time.

In a related matter, Israeli scientists, in collaboration with Swedish scientists have produced healthy offspring from mice who developed inside transplanted wombs from aborted fetuses.

This experiment that raises hopes of successful uterus transplants for women, but also has caused opposition from some pro-life groups.

Experts say the results, presented at the same European fertility conference, are encouraging but major obstacles remain, which must be overcome before women could benefit from the breakthrough.

Experiments led by Dr Tal Biron-Shental, of the Meir Hospital-Sapir Medical Center in Kfar Saba and Dr. Mats Brannstrom of Sahlgrenska University in Gothenburg, Sweden, involved genetically identical mice so there would be no problem of immune system rejection. The scientists sought to determine whether the wombs could be connected properly and function soundly.

Scientists grew tissue containing immature eggs from seven fetuses aborted between 22 and 33 weeks of gestation. The researchers removed ovary samples and froze them immediately. They later thawed them and cut them into thin slices before placing them in a dish of growth-enhancing chemicals and calf blood for four weeks.

The scientists concluded, based on an elevation of estradiol – a form of estrogen – in the fourth week, that some of the follicles had progressed from the resting state to the growing stage.

The procedure has caused opposition by pro-life groups on moral and ethical grounds because of the use of aborted fetuses, which the scientists say could be used in fertility treatment to overcome the shortage in human eggs.

The use of aborted fetuses would relieve a worldwide shortage of human eggs for fertility treatments, the researchers said.

Women are born with a finite number of eggs that diminish over time. For older women who want to have a child, an egg donated from a younger woman may be her only chance of success. But demand for donated eggs exceeds supply.

Biron-Shental said they have removed ovarian tissue, from aborted fetuses, which could mature into eggs that could be used in in-vitro fertilization (IVF) treatments.

“I am fully aware of the controversy about this, but most probably, in some place it would be ethically acceptable,” Biron-Shental, of the Meir Hospital-Sapir Medical Center in Kfar Saba in Israel, told the conference.

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