First off, let’s say it like it is. We know that the highlight of a man’s day isn’t visiting a fertility clinic to drop off a sperm sample. (Or better yet, producing one on-site). This is why the option of at-home fertility tests for men are so enticing. You can test your sperm in the comfort and privacy of your own home and receive instant results! Sounds great, right?
The problem is that at-home tests for male fertility only evaluate one (or two) factors at most, and only at the surface level. Would you be satisfied if a cancer screening only tested a third of your body? We’re guessing no.
When sperm is tested by an andrologist (a specialist in male reproductive health) and urologist, they are making an evaluation based on multiple different factors.
Male fertility factors
Sperm count or concentration
This assesses the amount of sperm in a sample. This is sometimes reported as Sperm Count, or divided by its volume to calculate a Sperm Concentration. This should be 15 million sperm per milliliter or more. If numbers are lower, an issue with sperm production or blockage may be present. While 15 million per milliliter might be normal, if there are ways to make it higher, wouldn’t you want to know?
Motility
This evaluates whether sperm is moving and assesses the percentage of dead or non-motile sperm. A normal range has 40 percent or more moving, but a simple assessment of motility doesn’t necessarily assess whether the sperm are moving with purpose or spinning around in circles. We typically would want to know about the amount of progressive motility, too. When numbers are lower, it can indicate a number of issues such as hormonal problems, varicocele (sort of similar to a varicose vein in the scrotum), or exposure to toxins such as chemicals, cigarettes, alcohol, or drugs.
Morphology
This factor focuses on the shape of the head, neck, and tail of sperm. Abnormal sperm can have a misshapen head, irregular neck, and tails that are broken, coiled, or multiple in number. Abnormal morphology may mean the sperm cannot successfully fertilize the egg, and may even play a role in embryo development.
Volume
The volume of a sperm sample can be a helpful indicator of issues. A normal volume is between ¼ – 1 teaspoon. A lower volume can simply be dehydration but can also indicate a blockage or issue with sperm going backwards into the bladder. Lower semen volume may hamper access of adequate sperm to the cervix.
Total motile count
This calculates the total amount of moving sperm. The normal range has at least 20 million moving sperm, but an optimal sample has 40 million or more. For men with a total motile count of 10-20 million, intrauterine insemination (IUI) may be helpful. For men with less than 10 million, in vitro fertilization (IVF) may be recommended.
Additional factors
A semen analysis also reviews other important factors such as the presence of problematic inflammatory cells or cellular debris that might impact the quality of the specimen.
At-home tests don’t tell the whole story
At-home tests focus primarily on numbers for sperm count and/or motility on a very basic level. The quality of the motility (for example, are the sperm moving straight ahead or spinning in circles) is not evaluated in a home test. The costs can range from $50-199 and there is no way to confirm whether the results are being calculated by a machine or an experienced professional. If you read the fine print, these tests also clarify that a test result does not clear the user of fertility issues.
In our experience, abnormal morphology is the single most common finding despite a man having normal count and motility levels. Abnormal morphology is also the most likely to be present in previously fertile men due to the variability of the findings and changes in other factors mentioned above.
Should you do an at-home test and receive concerning results, the next step will be to see a physician. Your physician will need to do a full semen analysis, which means you’ll be paying for testing twice.
Remember that a single semen analysis does not tell the whole story, whether normal or abnormal. Careful evaluation by an andrologist and review by a reproductive endocrinologist can make interpretation and recommendations valid and efficient.
If you do receive unexpected results, know that there are ways to boost fertility naturally in men, and treatment available when needed. Sperm regenerates every 90 days, so any positive changes can take effect relatively quickly. Making lifestyle changes such as eating healthy, exercising, quitting cigarettes and vaping, cutting down on alcohol and staying away from cannabis can make a huge difference. Taking 200 mg twice a day of enzyme CoQ10, 1000 mg of fish oil twice daily and a daily multivitamin with folic acid can improve sperm health and quality.
Medical contribution by Samuel Ohlander, M.D.
Dr. Samuel Ohlander is committed to building a trusting relationship with his patients by providing honest, compassionate, and collaborative care. He is board certified in Urology and specializes in male infertility, fertility preservation, low testosterone, vasectomies, and microsurgical vasectomy reversals.
