Because male infertility has no outward signs or symptoms, the only way to find out if there is an issue is to have your semen tested. The most thorough test is a clinical semen analysis, which can be done by a urologist or a fertility clinic. Over-the-counter tests are also available, and enable convenient at-home testing.
Finding a Doctor
No matter which testing option you choose—a home test or a full clinical analysis—it is important to discuss the results with a doctor. It is appropriate for men and women to see different specialists, and finding a male fertility physician can be a tricky task.
Women traditionally visit an OB/GYN, who may refer them to a fertility clinic staffed with Reproductive Endocrinologists, many of whom are OB/GYNs with two additional years of training in fertility. These doctors are experts in understanding the female hormone cycle and causes of fertility issues in women.
On the male side, fertility issues are commonly handled by urologists. These specialized surgeons commonly perform vasectomies and treat prostate problems. Andrology is the sub-specialty of Urology that focuses on reproductive health. Unlike on the female side, there isn’t a board certification program in Andrology, so it is harder to find male fertility specialists. While all urologists can run the basic tests of semen analysis and physical exam, it is important to contact a specialist if there is an issue. Some male fertility issues are plumbing problems that can be resolved with corrective surgery by a urologist. Others are related to hormonal imbalances, genetic conditions, or other causes which general urologists may be less confident diagnosing or treating. A fertility specialist sees all sorts of cases, and can treat a diverse range of problems.
Many of the leading researchers in male sexual health have found significant links between poor semen quality and general health conditions such as cancer, heart conditions and diabetes. For this reason, a fertility specialist will review your lifestyle, medical record, and family history to get a more complete understanding of your overall health and possible risk factors.
Beyond finding a specialist, it is important to find a doctor that you feel comfortable with. See our Find a Doctor tool for a list of male fertility specialists near you.
A full male fertility workup includes recording family history, performing a semen analysis, conducting a physical exam, and occasionally other tests. Blood work is used to test hormone levels, ultrasounds diagnose plumbing issues, and genetic tests identify conditions that may degrade semen quality. The main test is the clinical semen analysis, which provides a great deal of information on the quality of the sperm. In recent years a number of home testing options have come onto the market to help couples do some initial screens in the privacy of their own homes. The following review explains how clinical and home tests work and what kind of information they each provide. Regardless of which testing option you choose, it is a good idea to follow a few steps to prepare so that you get the most accurate results.
Clinical Semen Analysis
Cost: $100-300 plus consultation fees
How it works: A semen analysis is the most comprehensive way to diagnose male fertility issues. A semen sample is typically collected on-site and given to technicians who perform a variety of laboratory tests on it. The total volume of the sample is noted, and its pH is measured. Viscosity changes are observed over an hour as the sample rests. Semen normally liquefies over time due to enzymatic action, and failure to do so may detrimentally impact fertility as high viscosity can impair the ability of sperm cells to swim to their intended destination.
After the resting period, a technician mixes the sample with a solution to dilute it. A few drops of the dilute sample are placed on a special ruled microscope slide called a hemocytometer which allows them to visually count the number of sperm present in a fixed volume (concentration). In addition to count, the technician may also grade the quality of movement of each sperm cell (motility), the shape of the sperm (morphology) and whether they stick together (agglutination). The sperm concentration is multiplied by the original semen volume to get a total sperm count. The technician will also look to see if other types of cells are present, such as white blood cells, which can indicate infection. All of the data gathered at the laboratory is given to the physician for consideration. See our page on Understanding Results.
Strengths: The semen analysis is a very thorough test that explores all the characteristics of semen that are important for fertility.
Limitations: Some laboratories use a computer-aided system (CASA) to perform an analysis of images captured on the microscope. Doctors have said that these systems can sometimes make mistakes and if the doctor suspects an error they will request a manual count performed by a technician. While the technicians are incredibly well-trained and good at what they do, there is a bit of subjectivity that comes into play when manually counting cells and determining their morphology and motility. Because it is subjective and difficult to do, many clinics do not look at morphology. Additionally, studies show that semen analysis performed on the same sample by two different operators can vary by as much as 30%. So it should be considered more of an estimate, rather than an exact measurement. It is also widely documented that sperm counts vary from day to day and week to week. For this reason, the WHO recommends that at least two separate tests are performed days or preferably weeks apart to truly assess semen quality.
Also it is important to keep in mind that semen analysis is not a true test of fertility. Sperm counts, motility, morphology and the like are correlated with success rates but men with high numbers have had fertility troubles and men with low numbers have been able to conceive naturally with little problem. Semen analysis results do however help identify medical conditions related to the male reproductive track and are a good barometer of overall health in men. If you are struggling with unexplained fertility and semen analysis comes back good, it might be useful to request sperm function tests which can identify if sperm have trouble fertilizing an egg. Because sperm are involved with early cell division and development of embryos sperm function tests can also rule out causes of unexplained miscarriages.
How it works: The Micra is a home microscope kit that allows you to be your own lab tech. Semen is diluted using a liquid solution that comes with the kit. A dropper full of diluted sample is placed on a slide and sperm cells are counted on a grid that is visible by looking through the eyepiece.
Strengths: What’s really nice about the Micra is that is mimics the actual clinical test. The user can get some measure of both count and motility. The magnification isn’t high enough to clearly see morphology. This test has reusable supplies, so you can perform multiple tests and see how things change over time. Semen quality varies greatly from day to day so it is useful to do more than one test to get a good idea of general trends in sperm count.
Limitations: The fact that the test mimics the clinical test is also a disadvantage. Laboratory technicians are highly trained for analyzing cells under a microscope, and it may be difficult for someone to do this analysis at home with a plastic microscope. Sperm cells are particularly challenging to count as they can move not only from left to right on a microscope slide, but also up and down—causing them to drift in and out of focus. Because the equipment is lower quality than what the technicians in the lab use, it is difficult to focus the microscope correctly, and challenging to use it to get an accurate count.
How it works: This test works similarly to a pregnancy test. Semen is collected and placed in a liquefaction cup, which has enzymes that speed up the natural liquefaction process. A dropper full of liquefied sample is then mixed with a chemical that opens the sperm cells and releases their internal proteins into solution. A drop of this solution is then placed on a test strip. One blue line appears on the strip if you have fewer than 20 million sperm cells per milliliter, and two blue lines appear if you have more than 20 million sperm cells per milliliter.
Strengths: The major advantage of the SpermCheck is that it offers a quick and inexpensive at-home way to see if you have more than 20 million sperm cells per milliliter.
Limitations: The information provided by the SpermCheck is limited; it does not give a specific sperm count, but rather only if the count is above or below 20 million cells per milliliter Studies have shown that there is a direct correlation between sperm count and fertility. The more sperm you have, up to about 55 million cells per milliliter, the greater the chance of pregnancy. The SpermCheck also does not provide information about cell motility or morphology which are significant factors in determining male fertility.
Cost: $199 for the system (including 4 tests). A 2-test refill pack is also available for $49.
How it works: The Trak system is built on principles of centrifugal microfluidics – which means it spins. Semen is collected and placed in a liquefaction cup, which has enzymes that speed up the natural liquefaction process. A dropper of the liquefied sample is placed in the disposable test prop which is loaded onto the Trak Engine. Once the lid is closed the engine will spin the sample down. The sperm cells will form a pellet in the channel at the bottom of the test prop. The height of the pellet corresponds with sperm concentration (sperm count), categorized as Low, Moderate, or Optimal for conception. The product has a complementary mobile app (Trak: Sperm Health & Fertility) that helps users understand results and also learn about health and lifestyle steps you can take that are known to improve sperm production.
Strengths: Trak provides a convenient way to not only test at home, but to track your sperm count over time. A higher sperm count can boost your chances of conception – Trak can help to optimize your sperm production.
Limitations: Like other home tests, Trak is not a replacement for clinical semen analysis which will measure other sperm parameters such as motility, morphology, pH, etc.