Effect of semen collection location on semen parameters and fertility outcomes and implications for practice in the COVID-19 era: a systematic review and meta-analysis of randomized and observational studies

OBJECTIVE: During the COVID-19 era, semen collection at infertility centers might increase the risk of spreading SARS-CoV-2. Seminal fluid collection at home is an alternative method for preventing this spread. However, there is no conclusion about the effect of home vs clinic semen collection on semen parameters and assisted reproductive technology outcomes. This systematic review and metaanalysis aimed to assess the effect of semen collection location on semen parameters and fertility outcomes. DATA SOURCES: A literature search was conducted using the major electronic databases including MEDLINE via Ovid, EMBASE, Scopus, CINAHL, OpenGrey, and CENTRAL from their inception to September 2021. ClinicalTrials.gov was searched to identify the ongoing registered clinical trials. STUDY ELIGIBILITY CRITERIA: We included all human randomized controlled trials and observational studies that investigated the effect of at-home semen collection vs in-clinic semen collection on semen parameters and fertility outcomes. METHODS: We pooled the mean difference and risk ratio using Review Manager software version 5.4.1 (The Cochrane Collaboration, 2022). The Grading of Recommendations, Assessment, Development and Evaluations approach was applied to assess the quality of evidence. RESULTS: Seven studies (3018 semen samples) were included. Overall, at-home semen collection results made little to no difference in semen volume (mean difference, 0.37; 95% confidence interval, −0.10 to 0.85; low-quality evidence), sperm count (mean difference, −6.02; 95% confidence interval, −27.26 to 15.22; very low-quality evidence), and sperm motility (mean difference, 0.76; 95% confidence interval, −4.39 to 5.92; very low-quality evidence) compared with in-clinic semen collection. There was no difference in fertilization rate (risk ratio, 1.00; 95% confidence interval, 0.97–1.03; very low-quality evidence) and pregnancy rate in in vitro fertilization (risk ratio, 1.04; 95% confidence interval, 0.86–1.25; very low-quality evidence). CONCLUSION: At-home semen collection had no adverse effects on semen parameters or fertility outcomes compared with in-clinic collection. However, higher-quality evidence is needed.