Home Tests for Male Infertility: What Is Their Role?

Male fertility testing requires two things: physician assessment and semen analysis in an andrology lab. The introduction of home sperm-testing kits — some now including smartphone-driven devices — hasn’t changed that, says Sarah Vij, MD, Director of the Center for Male Fertility at Cleveland Clinic.

But there is a role for home test kits, particularly for men who don’t have a fertility specialist nearby or hesitate to go to one.

“There aren’t high-quality andrology laboratories everywhere in the world,” says Dr. Vij. “At-home semen analysis gives preliminary information to men, wherever they are. And it can be useful for men who are self-conscious about giving a semen sample in an office setting, or who won’t do it for cultural or religious reasons.”

Home tests offer early screening and may help men determine if they should see a specialist for formal evaluation.

Dr. Vij authored a review article on the topic, recently published in Panminerva Medica.

Improving the quality of home test kits

In 2012, the Food and Drug Administration (FDA) approved the first home fertility test for men. Today, several FDA-approved test kits are available.

Each uses a different mechanism and provides different information. Some report merely whether sperm are present or absent — which is useful only to the post-vasectomy patient population, says Dr. Vij. Others measure concentration of sperm (quantity per milliliter of semen) — but this is only a fraction of what is reported on a formal semen analysis.

“If you have 100 million sperm but none are moving, you won’t be fertile,” explains Dr. Vij.

Smartphone-based kits are more advanced, she says. They use the smartphone’s light and camera to record a close-up video of a sperm sample. Most kits require attaching the phone to another device to evaluate sperm concentration and motility, similar to computer equipment in an andrology lab.

For example, Yo (the first smartphone-based sperm-testing kit to be approved by the FDA) comes with a device that attaches to a smartphone and acts as a tiny microscope. Men use a dropper to apply a sample of ejaculate onto a slide, which is inserted into the device. The Yo app calculates concentration of motile sperm.

Home test kits vs. lab testing

Home test kits differ significantly from laboratory semen testing, says Dr. Vij.

In an andrology lab, semen is evaluated both manually (by microscope) and/or by computer to determine:

• Exact concentration.
• Vitality.
• Motility.
• Ejaculate volume.
• Acidity (pH).
• Morphology.
• And sometimes more detailed characteristics.

“Laboratory testing gives a much more thorough assessment,” says Dr. Vij. “I wouldn’t make any treatment decisions for a couple based solely on the results of a home sperm test. Men still require a formal assessment if there’s trouble getting pregnant.”

When to use home testing

Home testing will not replace a professional fertility workup, says Dr. Vij.

“If home test results show a man has low sperm count, he’ll need to see a fertility specialist,” she says. “But even if the results are normal, there could still be male-factor infertility. He could still need a fertility assessment.”

However, there may be some situations where home testing can stand alone, notes Dr. Vij. Men with known risk factors for infertility (e.g., removed testicle) can get a quick check to be reassured they’re fertile before attempting pregnancy. Currently, most men aren’t checked for infertility until couples have been unsuccessful at pregnancy for 12 months. A home test may help reveal potential problems sooner.

Home test kits also may be valuable in the future for testing men post-vasectomy, suggests Dr. Vij. Surgeons often recommend that patients verify their sterility a few months following vasectomy, before resuming unprotected intercourse. Compliance is typically poor, she says, but might improve if men can test themselves at home. At present, these tests are not validated in the post-vasectomy population.

“Home testing, even with more advanced smartphone-based methods, is an adjunct to the services offered by fertility specialists,” says Dr. Vij. “Most of us who do this for a living are excited about its potential but we still believe the in-office assessment is critical.”