A Beginner’s Guide to Male Fertility Testing - Path Fertility

A Beginner’s Guide to Male Fertility Testing

Men contribute to infertility 50% of the time

Medically Reviewed by Dr. Kevin J Campbell, MD, a fellow in Male Reproductive Medicine and Surgery at Bayor College of Medicine in Houston, TX, with Dr. Larry Lipshutlz. 

We can’t say it enough. Infertility isn’t just a female issue. Men are responsible for or contributing to infertility roughly 50% of the time. If a couple is struggling with infertility, of course the female partner should get check and there are a lot of options out there for evaluating female fertility. However, there is a lot less focus, and fewer options, when it comes to evaluating male fertility.
We’ve put together a list of everything you can use to help evaluate the male side of this very complex problem. It’s a short list. The fact is there aren’t that many options out there for men.

Semen Analysis: The Universal Standard

The cornerstone of the fertility evaluation is a semen analysis. This gives your doctor a baseline for evaluating male fertility. A semen analysis shows whether or not a man has sperm in his semen, and also provides information about the sperm’s shape and movement. There is a range of semen analysis options out there from simple over-the-counter tests to a thorough examination at a lab by a professional technician.

Over-the-Counter Sperm Tests
  • Inexpensive: $30-$100
  • Easy to acquire/take
  • Uncertain quality control or reproducibility
  • Limited information provided

These are simple versions of a semen analysis that are easy to buy, low cost, and have limited clinical value. They can be purchased from pharmacies for $30-$100 without any doctor involved. If you aren’t trying to conceive right now and are just interested in learning more about your fertility, these are a possible option. However, these products are not intended to be a replacement for a laboratory semen analysis and result interpretations may vary.

On the more inexpensive end, you have products like SpermCheck which functions just like a pregnancy test, but for male fertility. A test stick is placed in a cup with your sample and then gives you one or two blue lines that tell you if you have more or less than 20 million sperm cells per milliliter. If you have more than 20 million sperm present, your sperm count may not be a cause of infertility.

On the more expensive end, you have mail-in semen analysis kits that function the same way as a lab semen analysis, but without the need to go to a clinic and provide the semen specimen on-site.

Clinical Semen Analysis
  • More expensive $100-$300
  • Professionally done
  • More thorough, in-depth information
  • Contributes to a treatment plan

If you are trying to conceive you need your semen analysis to be performed at a lab, by a professional. The lab will have the equipment and expertise to provide meaningful results. Even more importantly, your clinical semen analysis results will be evaluated by a doctor.

Even with a clinical semen analysis, doctors will often have to test performed at least twice at different times because semen parameters regularly fluctuate.

Semen Analysis Parameters

Below are the most common parameters of a laboratory semen analysis. Even if these gross parameters look normal, a semen analysis can’t tell you that you are or are not fertile. Sperm isn’t always as healthy as it looks. The semen analysis just rules out a few common male fertility problems. This is an important step to take. Remember infertility is a complex problem, sometimes with no one cause, and your doctor needs information to provide the best treatment.

  • Sperm Concentration: Is a measure of how many sperm are present per milliliter of semen produced. Ideally, this is greater than 15 million sperm/milliliter.
  • Motility: This is an evaluation of how well the sperm are moving. More than 40% is considered normal.
  • Morphology: This is a measure how many of the sperm have normal shape. Doctors look for at least 4% normal morphology, but this is considered the least significant semen parameter for fertility.

Hormone Testing

Hormone testing is one valuable tool for identifying the cause of sperm production problems. However, if sperm production isn’t the problem, hormone testing may not be especially valuable and on the other hand, normal hormone levels do not mean there is no fertility problem.

FSH (follicle stimulating hormone) is one hormone important for sperm production. Normal levels should range between 1.5 to 12.4 mlU/mL.

Testosterone is the other hormone closely tied to sperm production. The normal range is 300 to 800 or 300 to 1,000 nanograms per deciliter depending on the laboratory.

DNA/Genetic Fertility Testing

A semen analysis can ellucidate some potential male fertility problems, and provide a doctor with a strong baseline for understanding what’s going on with a man’s fertility. However, the results often aren’t conclusive. Consider that 1 in 5 couples who seeks fertility treatment has unexplained infertility. In many of these cases, sperm may be there, but it isn’t functioning properly. For a more complete picture of male fertility, you may obtain a test that looks at the integrity of DNA.

DNA Fragmentation

There are a few tests available that look at sperm DNA fragmentation, or damaged and broken DNA. Evidence suggests that DNA fragmentation can be a marker for infertility.  DNA fragmentation tests are primarily used to help you understand the risk for IVF failure or early pregnancy loss.

Tests for Sperm Production Issues

If a man is diagnosed with oligospermia (low sperm count) or azoospermia (complete absence of sperm) there are tests that can help further identify the cause of the production issue. If little or no sperm is showing up in a man’s semen the problem could be blockage. Additional imaging such as ultrasound tests can help identify if there is blockage, as well as where it is in the reproductive tract.

If the problem isn’t blockage, a testicular biopsy can be performed to help understand how well sperm are being produced.

Tests for Motility Issues

If motility has been identified as an issue, there are tests that check for antibodies in the blood that might impede a sperm’s ability to reach the egg by attaching to the tail of a sperm or by causing the sperm to clump together.

Tests for Penetration Issues

There are several tests that evaluate sperm penetration such as: Acrosome Reaction Test, Sperm penetration Assay, Hemizonal Assay Test, etc. However, once egg penetration has been identified as the problem, the solution will likely be ICSI, in which a single sperm is injected directly into an egg.

Kristin Brogaard, PhD

Kristin Brogaard, PhD is Co-founder and COO of Inherent Biosciences, a molecular diagnostics company at the intersection of epigenetics and AI. Dr. Brogaard is an experienced molecular biologist, study director, and operations manager for early stage biotech startups. She received her PhD in Molecular Biology from Northwestern University developing novel epigenetic technologies. She subsequently worked with Dr. Leroy Hood, a pioneer in personalized medicine technologies, first as a post-doc and then as a colleague launching a novel scientific wellness start-up, Arivale. Dr. Brogaard has broad business experience that includes launching and scaling the health startup, Arivale. Additionally, Dr. Brogaard was the Director of Program Management at Arivale managing all strategic projects with a highly qualified team of program and project managers.

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