Low to non-existent sperm content of pre-ejaculate in perfect-use contraceptive withdrawal, a pilot study.

Objective: To assess pregnancy risk following perfect use of the withdrawal method by quantification of sperm in pre-ejaculate.

Study design: We conducted a pilot study of sperm and factors linked to its presence in pre-ejaculate samples among healthy, reproductive-age, withdrawal-experienced men. Participants provided up to three paired pre-ejaculate and ejaculate specimens in 72-hour intervals. We analyzed samples for volume, consistency, sperm concentration, count, and motility. We set clinical pregnancy risk as our primary outcome, defined as sperm concentration >1million/mL.

Results: From 70 paired samples (N = 24 participants, median age: 27 years), we identified sperm in nine (12.9%) pre-ejaculate samples, from six (25.0%) participants. Only seven samples contained sperm in concentrations of significant clinical pregnancy risk. All ejaculatory specimens contained motile sperm in concentrations of significant pregnancy risk.

Conclusion: In this study of the pre-ejaculate of perfect-use withdrawal users, motile sperm were usually absent, or found inconsistently and in insufficient quantities to confer significant clinical pregnancy risk.

Implications: While correct and consistent withdrawal use is likely to be highly effective, given that motile sperm in concentrations >1 million/mL are usually absent or inconsistently present in pre-ejaculate, clinical trial data is lacking.