Testing Sperm at Home: The Latest Infertility Trend

Peter Kovacs, MD, PhD

Disclosures

February 06, 2020

"Should I use one of those home testing kits to check my sperm?" This question, or one like it, can now be heard in the examination room as men become increasingly concerned about their fertility amid reports of declining sperm counts in the United States.

For some men, it's an attractive option—sperm testing in the privacy of one's own home. Forget the anxiety about being able to produce a sample under the harsh fluorescent lighting of a public men's room. No awkward passing of the sterile container—empty or full—between patient and clinic staff. In 30 minutes or less, a man can find out whether his sperm count is low or be reassured that it's normal.

Men and their sperm are the latest focus in the highly profitable business of baby-making as sperm tests join the booming do-it-yourself at-home health testing market. But is a home sperm kit a valid test of a man's ability to fertilize an egg or just a gimmicky waste of money?

Home Sperm Tests on the Market Now

Most home sperm tests are basic measures of sperm count (and in some cases, sperm motility) but give no information on sperm morphology or other biochemical characteristics.

Several home-based tests to date have been approved by the US Food and Drug Administration. Some are single-use test kits containing the supplies to collect semen, prepare it, and transfer it to a test strip. Others are smartphone-based technologies that include microscopes that work in tandem with a phone or tablet's camera. Costs range from about $25 to $90.

SpermCheck Fertility (DNA Diagnostics Center; Fairfield, Ohio) is a test strip using immunoassay technology that gives a positive result when the sperm count is > 20 million/mL (reference range, 15-213 million/mL) or negative result when the sperm count is lower.

Figure 1. SpermCheck Fertility home test kit.

Another product by this company, SpermCheck Vasectomy (DNA Diagnostics Center; Fairfield, Ohio), indicates whether the sperm count is high or low (posing a low risk of pregnancy). Two tests are recommended when used for this purpose.

The SwimCount Sperm Quality Test (HoMedics; Commerce Township, Michigan) also uses antibodies to detect motile sperm. After the semen sample is collected, it is left to liquefy for 30 minutes before 0.5 mL is transferred to the sample well of the device. The motile sperm result can be read in another 30 minutes (low: < 5 million/mL; normal: > 5 million/mL).

Figure 2. SwimCount Sperm Quality Test home test kit.

The Trak Male Fertility Testing System (Sandstone Diagnostics; Pleasanton, California) uses an engine-powered centrifuge to spin the semen sample that is loaded into a cartridge and provides a three-category sperm concentration result in 6 minutes (low: < 15 million/mL, moderate: 15-55 million/mL, and optimal: > 55 million/mL). Trak also supplies a volumetric collection cup that allows users to estimate semen volume. Refill kits are available.

Figure 3. Trak Male Fertility Testing System

Smartphone-based sperm tests allow men to actually visualize their sperm activity. The first of these approved in the United States is the YO Home Sperm Test (Medical Electronic Systems; Los Angeles, California) that uses a clip-on device to turn a phone into a microscope and records a live video. Software determines the motile sperm count, which is reported as a normal (> 6 million/mL) or low (< 6 million/mL) result.

Figure 4. YO Home Sperm Test, showing the device clipped onto a smartphone.

Home sperm testing differs from the recent spate of mail-in sperm storage start-ups. Home test kits allow the user to perform the test himself, whereas mail-in companies provide a temperature-controlled collection kit for a fee. The user then sends the semen sample to the company who conducts the analysis, and for an annual fee, will freeze and store the sperm for later use.

Why Men Test Their Sperm 

When pregnancy doesn't happen as fast as expected, some couples start worrying about infertility—the inability to conceive after 1 year of unprotected intercourse. Infertility affects approximately 15% of those who wish to start a family. For a long time, infertility was deemed a "female problem." Lately, with the understanding that as many as 40% of cases could be related to the male partner and that sperm contributes more than DNA to the embryo, the need for improved evaluation of male factor infertility has been increasingly evident.

Home sperm testing could be a good first-line option for couples in whom significant problems are not suspected in the female partner (ie, regular menstrual cycles, younger age, relatively short duration of infertility, and no pelvic pathology or previous surgery). Even if a couple isn't ready to consult a fertility specialist, the male partner may want to check his sperm count to rule out problems on his end before that step is taken.

These tests could also be a boon for men who are reluctant to have the test done in a laboratory or those who want to conduct serial tests to monitor sperm count over time. In such cases, a positive result (indicative of a normal sperm or motile sperm count) could be reassuring. In addition, home testing might be used as a screening test when a more thorough urologic or andrologic evaluation is not readily available.

A concern about fertility isn't the only driving force in the popularity of home sperm tests. About one third of men who buy these kits are not actively trying to conceive but just curious about their sperm counts. After vasectomy, for example, recanalization can occur during the process of healing. Some men who have undergone a vasectomy may wish to confirm that it's safe to have intercourse without using contraception; however, current guidelines on vasectomy from the American Urological Association do not yet recommend using self-testing of sperm count for the purpose of postvasectomy semen analysis.

Finally, some men take drugs or supplements that are known to affect sperm production, including anabolic-androgenic steroids and testosterone. Others take supplements with the goal of improving testicular health and fertility. These men may want to evaluate the effect of these products on their reproductive potential.

How Accurate Is Home Sperm Testing?

If home testing accurately identifies a low sperm count, it could mean less stressful and more timely evaluation and treatment of infertility. On the other hand, an unreliable test could delay and impede this process. So, the question—whether home testing can substitute for a laboratory-performed sperm count—is an important one.

If all a man wants to know is his sperm or motile sperm count, home tests generally provide this information with high accuracy. The Trak Male Fertility Testing System has a reported accuracy of 82%-96% depending on the quality of the sample. The SpermCheck Fertility test has been shown to be 96% accurate in classifying the samples as normozoospermic, oligozoospermic, or severely oligozoospermic, and the SwimCount Sperm Quality Test is reported to be 93%-95% accurate.

According to Agarwal and colleagues, the YO Home Sperm Test results compared favorably with an automated laboratory sperm analyzer (more than 90% correlation), but the precision varied when different smartphones (iPhone vs Samsung Galaxy) were compared.

Counseling About Sperm Testing

Men should understand that home testing is not as precise or comprehensive as an evaluation by a medical provider, and sperm count testing is only one step in the evaluation of male infertility. In controlled laboratory testing, semen samples are obtained after 2-5 days of abstinence from intercourse, collected in a small cup or condom that is nontoxic to sperm, and analyzed within 30-60 minutes. Reference ranges are used to identify abnormal parameters in semen volume, pH, liquefaction, and various sperm parameters, including sperm count, motility, morphology.

A laboratory can assess the genetic composition of sperm and the intactness of its DNA content, its ability to undergo an acrosome reaction (needed to penetrate the egg), the extent of binding to the zona pellucida, and its fertilizing capacity. These parameters influence fertilization rates, embryo development, implantation, and miscarriage rates, and through epigenetic changes, can affect the health of the offspring. Crucial information is also learned from a physical examination and a review of the patient's reproductive and sexual history.

A complete evaluation of this type can help determine the most appropriate type of infertility treatment (eg, insemination, in vitro fertilization, intracytoplasmic sperm injection, donor gamete). However, for men who choose the home sperm testing route, a "normal" sperm count result could provide false reassurance because it doesn't necessarily mean that there are no treatable (functional) problems on the male side. Furthermore, in general, sperm count alone doesn't predict male fertility. For a couple who seeks medical help to conceive, the male partner probably will be retested during a comprehensive infertility workup, a key element of which is semen analysis. Delaying a proper evaluation of the male partner can actually have a negative impact on the couple's overall chance of conceiving.

The bottom line is that although it may satisfy the curiosity of men who are concerned about their fertility, a quick home testing of sperm count can't substitute for a thorough evaluation by a urologist or fertility specialist.

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