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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 (we’ve written about it here.) 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.
Now if you don’t already know, I want to disclaim up front that Episona offers a male fertility test, Seed, but we don’t offer the only valuable tool out there and our test isn’t necessarily the first step you should take either. With that in mind, let’s dive in to the limited options available to men with fertility problems.
Semen Analysis: The Universal Standard
The most commonly used male fertility test 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
- Little clinical value
- Limited information provided
These are simple versions of a semen analysis that are easy to buy, low cost, and of little clinical value. They can be purchased from any pharmacy 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 great option. However, these products are not intended to be a replacement for a laboratory semen analysis.
On the low 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. This might satisfy your curiosity, but it won’t help at all with informing treatment.
On the higher end, you have home microscope kits that function the same way as a lab semen analysis, but without the advanced equipment or expertise of a lab technician. Again, an interesting test for learning about how male fertility is assessed, but not an effective tool to help you conceive.
Get a 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. Your semen parameters don’t give you a complete picture of your fertility and trying to interpret results on your own will be less effective, and more stressful, than looking at them with a doctor.
Even with a clinical semen analysis, doctors will often have to test performed 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 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 of the most common male fertility problems. This is an important step to take. Remember infertility is a complex problem 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. You want at least 15 million/milliliter.
Motility: This is an evaluation of how well the sperm are moving. You want at least 40% to have regular movement.
Morphology: This measures how many of the sperm have normal shape. Doctors look for at least 4% normal morphology, but this is considered the least important semen parameter for fertility.
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 be between 5 to 10 mlU/mL.
Testosterone is the other hormone closely tied to sperm production. The normal range is 300 to 1,111 nanograms per deciliter.
DNA/Genetic Fertility Testing
A semen analysis can eliminate 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 need a test that looks at the level of DNA.
Seed: An Epigenetic Male Fertility Test
Our test, Seed, looks at problems with individual genes in your DNA and gives you more specific information about what is happening with your case. Humans have a wide variety of genes that correlate with fertility in some way, and new research into gene function is constantly underway. Seed examines the abnormalities in your genes and provides you with a risk for both male factor infertility and poor embryo development. Different genes impact different areas of fertility. TAS2R60 for example is a gene that is thought to have an important role in helping sperm “find” the egg and the gene CATSPER has a well-documented role in helping sperm penetrate the egg. While ID3 is important for embryo development. By showing where abnormalities are occurring, Seed can help your doctor guide treatment.
Your Seed test results help you understand if you should keep trying naturally before moving to IUI, or maybe your case is quite severe and you should move directly to IVF ICSI. If you’re thinking about IVF or have already had a failed cycle, you need information to help decide if you should keep trying. Seed helps you understand your risk for further failed cycles and can help you identify where the problem is occurring.
There are a few tests available that look at sperm DNA fragmentation; damaged or broken DNA. Evidence suggests that DNA fragmentation is a marker for infertility. It is found in 5% of infertile men with normal semen analyses and 25% of infertile men with abnormal semen analyses. DNA fragmentation tests are primarily used to help you understand the risk for IVF failure or early pregnancy loss.
Other Less Frequently Used Male Testing Options
Beyond a medical evaluation, a semen analysis, and DNA testing, there are very few tests that are regularly used. What other tests do exist frequently look at a very specific problem that has already been identified, at which point further testing may not impact treatment.
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. X-ray and 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, Hemizona 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.
What Male Fertility Testing Can and Can’t Tell Us
As you can see looking through the list above, the majority of male fertility testing looks at two questions: Do you have sperm? And can it reach an egg?
These are important first questions to answer and that’s why male fertility testing should start with a trip to the urologist and a professional laboratory-performed semen analysis. However, the reality is that infertility is a highly complex, multifaceted problem. A semen analysis often doesn’t give a clear or complete answer. You want a child and more information into the cause of your fertility problems is going to help your doctor guide you to the best treatment for your case.
This is where an advanced test, like Episona’s Seed test, can help identify problems even when a semen analysis looks normal. Used up front with a semen analysis, the Seed test can help you understand if you should keep trying naturally before moving to IUI, or show that your case is quite severe and you should consider moving directly to IVF ICSI. An advanced screening test doesn’t diagnose fertility, it can’t tell you that you absolutely are or are not fertile, but it can help you understand your risks as you begin treatment. This can save you serious time and money on your journey to becoming a dad.