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Total number of sperm per ejaculate (TSperm) is an important measure for clinicians to provide advice to patient couples. However, TSperm/hour of abstinence is a better measure for epidemiologist-andrologist teams or clinicians to evaluate spermatogenesis (ie, rate of sperm production). This review looks at the interplay and impacts of rate of sperm accumulation in the excurrent duct system, abstinence interval, sexual arousal, and masturbation versus intercourse on observed TSperm. It also examines why and when TSperm/hour might provide a meaningful quantitative evaluation of spermatogenesis. Intercourse while wearing a modern semen collection device might give more sperm than masturbation, but well designed studies of this or effect of sexual arousal on TSperm are lacking. There is no doubt that TSperm increases with longer abstinence, and in different men plateaus after 3-9 days. Clinicians wishing to maximize number of fully functional sperm available during intercourse, or for artificial insemination, might wish to recommend 6-7 days abstinence. Diagnostically, the important feature is TSperm/hour of abstinence. After 24-36 hours abstinence TSperm/hour is deceptively high, for reasons discussed. After abstinence interval exceeds 64-72 hours, TSperm/hour abstinence starts to decline in nonoligozoospermic men as the rate of sperm accumulation in the excurrent ducts approaches zero; apparently increasingly more sperm are voided in urine. Clinicians or epidemiologist-andrologist teams wishing to have optimal distinction among individuals with high, typical, or low sperm production (ie, normal or abnormal spermatogenesis) should measure TSperm/hour for samples provided after 42-54 hours abstinence (never 
36 or >64 hours). Longer abstinence intervals reward men with poor sperm production because sperm can accumulate in the excurrent ducts for 
7 days abstinence, and penalizes men with good sperm production because after 3 days abstinence their excurrent ducts probably are full.
Key words: Epididymis •
Semen •
Semen Analysis •
Spermatogenesis •
abstinence interval •
sexual arousal •
total sperm per ejaculate
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