Does shorter ejaculatory abstinence improve intra uterine insemination outcomes in couples with unexplained...

To assess the impact of duration of ejaculatory abstinence on live birth rates in Intrauterine Insemination (IUI) cycles.

Retrospective cohort study at a university-level tertiary care centre from January 2019 to June 2023. A total of 573 cycles in 463 couples with unexplained infertility were included in the study. We had three cohorts based on the duration of ejaculatory abstinence: Group I - ≤ 2 days, Group II - 3-7 days, and Group III - > 7 days. The primary outcome assessed was the live birth rate per IUI cycle. Secondary outcomes included pregnancy rate per cycle, clinical pregnancy rate per cycle, and miscarriage rate per clinical pregnancy.

The live birth rate per cycle was 9.6 % in Group 1, 9.3 % in Group 2, and 18.8 % in Group 3, and there was no statistically significant difference among the three cohorts (p = 0.230). The clinical pregnancy rate per IUI cycle was 11.7 %, 12.0 % & 18.8 % in groups 1, 2 & 3, respectively, which was comparable among the groups (p = 0.474). Logistic regression analysis done after adjusting for potential confounders showed no significant association of ejaculatory abstinence with live birth {adjusted odds ratio (aOR) for group1: 0.93 (95 % CI 0.50 - 1.73, p = 0.827), for group 3: 2.58 (95 % CI 0.90 - 7.36 p = 0.076)} with group 2 as the reference.

For couples with unexplained infertility undergoing IUI, a shorter ejaculatory abstinence period of ≤ 2 days does not significantly enhance the live birth rates compared to standard or prolonged abstinence.