Objectives: We aimed to evaluate the association between increasing the frequency of ejaculation and ICSI outcomes for idiopathic oligoasthenoteratozoospermic (iOAT) male partners of couples undergoing ICSI.
Methods: The present prospective case-control study included 81 participants of iOAT men. The participants of the intervention group (n=44) received an instruction to change the lifestyle by increasing the ejaculation frequency and prescribed antioxidant therapy for 3months before ICSI. The subjects of the control group (n=38) received only antioxidant for 3 months before ICSI.
Results: A significant increase in the rate of top-quality blastocyst in the intervention group (42.9%) than in the control (24.7%), (RR: 0.76, 95% CI: 0.65-0.89, P=0.005) was detected. No significant differences in the rates of biochemical pregnancy (59% vs. 28.6%; RR: 1.2, 95% CI: 0.80–1.83), clinical pregnancy (52.3% vs. 37.8%; RR: 1.2, 95% CI 0.76–1.92), and implantation (37.8% vs. 27.9%; RR 1.4, 95% CI 0.88- 2.06] in the intervention group as compared to control were detected. Ongoing pregnancy rate was significantly higher in the intervention group than in the control group [RR 1.96, 95% CI 1.03-3.75; P=0.04). 
Conclusions: High frequency of ejaculation may significantly improve the rates of the top quality blastocyst and ongoing pregnancy on ICSI/OAT cycles when combined with antioxidant therapy. Although the study's sample size is small to detect the clinical outcomes, there is a trend toward better rates of clinical pregnancy and implantation. However, a larger sample size is warranted to detect whether these would be of true significance.