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 with Dr. Larry Lipshutlz, Professor of Urology, both at Baylor College of Medicine in Houston, TX. 

We can’t say it enough. Infertility isn’t just a female issue. For couples struggling with infertility, of course the female partners should get checked. Luckily, there are a lot of options out there for evaluating female fertility. However, men are responsible for or contribute to infertility roughly 50% of the time, yet there is a lot less focus and fewer options when it comes to evaluating male factors.
So what should you do if you’re wondering about your fertility status? We’ve put together a list of various tests and resources you can use to help assess the male side of this very complex problem.

Semen Analysis: The Current Standard

First, it’s important to understand the cornerstone of male fertility evaluation: semen analysis. 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. It’s typically the starting point when checking male fertility potential and provides a baseline of the following criteria.

Basic Parameters
  • Count: Measures the total number of sperm present in semen sample. Those with less than 39 million sperm per ejaculate are considered to have a low sperm count.
  • Concentration: Measures how many sperm are present per milliliter of semen produced. Ideally, this is greater than 15 million sperm/milliliter.
  • Volume: Measures the amount of semen produced in a sample. Between 1.5–7.6 mL is considered normal.
  • Motility: Measures how well the sperm are moving. More than 40% is considered normal.
  • Morphology: Measures 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.

Even if these parameters present as normal, a semen analysis can’t definitively say whether or not a person is fertile. Traditional semen analyses can rule out a few common male fertility problems but have only modest predictive power when it comes to pregnancy. Infertility is a complex issue, sometimes with multiple causes, and your doctor needs a lot of information to provide the best treatment plan.

What kind of semen analysis tests are there?

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 without any doctor involved. If you aren’t trying to conceive and are just interested in learning more about your fertility, these are a suitable option. However, these products are not intended to be a replacement for a laboratory semen analysis or medical advice since results may vary.

For example, products like SpermCheck function like a pregnancy test, but for male fertility. A test stick is placed in a cup with your sample and shows one or two blue lines depending 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.

There are also 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-$500
  • Ordered by a physician and professionally done
  • More thorough, in-depth information
  • Contributes to a treatment plan

If you are trying to conceive, your semen analysis should be performed at a lab by a professional and, more importantly, evaluated by a doctor. The lab will have the equipment and expertise to provide meaningful results. Even with a clinical semen analysis, doctors will often have patients get tested at least twice at different times because semen parameters regularly fluctuate.

Clinical semen analyses will show more trustworthy results than OTC options and can help physicians guide fertility treatments to a limited extent.

Epigenetic Semen Analysis: Path SpermQT
  • Mid-range: $385
  • At-home sample collection with CAP/CLIA lab testing
  • Epigenetic analysis of sperm
  • Offers more personalized guidance

Clearly, a semen analysis can elucidate some potential male fertility problems and provide a doctor with a strong baseline for understanding a man’s fertility. However, the results often aren’t conclusive enough. Consider that 1 in 5 couples who seek fertility treatment get a diagnosis of 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, Path SpermQT exists to evaluate the integrity of DNA.

Path SpermQT is an epigenetic male fertility test that looks at patterns within sperm DNA that indicate a sperm’s quality and functional ability to fertilize an egg. This information, combined with a traditional semen analysis, can help physicians to better assess whether IUI or IVF treatments are more likely to successfully lead to pregnancy. 

If you’re interested in learning more about Path SpermQT, visit our information for patients and providers.

Other Types of Testing

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.

Hormone Testing

Hormone testing can also be a valuable tool for identifying the cause of sperm production problems. However, if sperm production isn’t the problem, hormone testing may not be especially useful. Plus, normal hormone levels do not necessarily 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 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 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.

Have more questions about how to test your fertility potential? Contact one of our experts!

Kristin Brogaard, PhD

Kristin Brogaard, PhD is Co-founder and CSO 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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