Home Sperm Analysis: Beware the Pitfalls
"A little information can be a dangerous thing."
Once again, there is something new hitting the stores - a new test that measures sperm motility so couples at home can check their fertility status. Wow. At first this seems like a great idea. So easy, so comfortable, so inexpensive.
But there is a problem. In fact, a lot of problems. First, as a male fertility specialist that works with semen analysis daily as part of my vasectomy reversal program, motility alone is almost meaningless. What about the sperm count? What about semen volume? These numbers individually mean almost nothing. But when you look at the total count of motile sperm, which require all these numbers to be multiplied, then you have a number to start with. Then, anyone with any knowledge will tell you that you need two or three counts, each one after 3 days of sexual abstinence, each 8 weeks apart.
So how does this home quickie home test fit in? Especially since there are so many other important aspects of a semen analysis that are not addressed? My fear is that for most couples, they will assume that if their numbers come back "ok" then they will use that information to justify not seeing a male fertility specialist. Simply bad medicine.
But it gets worse. Many times men will have what looks like adequate numbers but could still have serious problems. Testicular cancer is found in one out of every 100 men that is evaluated at a specialty male fertility clinic - something that could not be detected on a home semen analysis kit. So what happens to those guys? Do they not know until the tumor has grown? Will men still go see a male fertility specialist for an exam? I doubt it.
Lastly, all the advances in human fertility and all the amazing miracles are a direct result and spin-off of animal/livestock fertility research. Yet something strange has happened over the past decade. Somehow, the human fertility specialists have lost touch with the animal researchers that are years ahead. Human fertility specialists still use sperm motility as a major marker for fertility. This has been shown to be of minimal importance in the animal world, which has now identified markers for fertility. Then why are we still looking at motility? That's a good question.
I am sure the kit will be a good tool to use in conjunction with a formal fertility evaluation. My experience suggests that most will not do this, and use the information from this home test to replace a doctor's exam and formal fertility testing. I hope I am wrong. A little information can be a dangerous thing.
Related Topics: Technorati Tags: male fetility, semen analysis, motility, testicular cancer, men's health, health and wellness
Once again, there is something new hitting the stores - a new test that measures sperm motility so couples at home can check their fertility status. Wow. At first this seems like a great idea. So easy, so comfortable, so inexpensive.
But there is a problem. In fact, a lot of problems. First, as a male fertility specialist that works with semen analysis daily as part of my vasectomy reversal program, motility alone is almost meaningless. What about the sperm count? What about semen volume? These numbers individually mean almost nothing. But when you look at the total count of motile sperm, which require all these numbers to be multiplied, then you have a number to start with. Then, anyone with any knowledge will tell you that you need two or three counts, each one after 3 days of sexual abstinence, each 8 weeks apart.
So how does this home quickie home test fit in? Especially since there are so many other important aspects of a semen analysis that are not addressed? My fear is that for most couples, they will assume that if their numbers come back "ok" then they will use that information to justify not seeing a male fertility specialist. Simply bad medicine.
But it gets worse. Many times men will have what looks like adequate numbers but could still have serious problems. Testicular cancer is found in one out of every 100 men that is evaluated at a specialty male fertility clinic - something that could not be detected on a home semen analysis kit. So what happens to those guys? Do they not know until the tumor has grown? Will men still go see a male fertility specialist for an exam? I doubt it.
Lastly, all the advances in human fertility and all the amazing miracles are a direct result and spin-off of animal/livestock fertility research. Yet something strange has happened over the past decade. Somehow, the human fertility specialists have lost touch with the animal researchers that are years ahead. Human fertility specialists still use sperm motility as a major marker for fertility. This has been shown to be of minimal importance in the animal world, which has now identified markers for fertility. Then why are we still looking at motility? That's a good question.
I am sure the kit will be a good tool to use in conjunction with a formal fertility evaluation. My experience suggests that most will not do this, and use the information from this home test to replace a doctor's exam and formal fertility testing. I hope I am wrong. A little information can be a dangerous thing.
Related Topics: Technorati Tags: male fetility, semen analysis, motility, testicular cancer, men's health, health and wellness
21 Comments:
Dr Marks makes some interesting comments about the Fertell home fertility kit that is now available in the US.
However, I differ in a major way with what he is saying. I believe that the cup is "half full" not half empty, when I think of this kit. I believe that "information is power" and not that information is dangerous to consumers. Besides the information obtained from the Fertell kit for semen quality is 95% accurate, so it is not misinformation. Regarding another point, a full 50% of men with testis cancer actually have abnormal semen quality on presentation and this kit suggests abnormal semen quality. That would seem to be a benefit in my book for diagnosing this condition, not missing it!
As a Men's Health specialist myself who sees 1500 young men annually with various problems, I am a little surprised that Dr. Marks has missed the bigger picture: in most couples with infertility the male partner never gets evaluated by a urologist, despite a male factor issue underlying the infertility problem in 30-40% of cases! Getting couples to use an at-home test for male fertility potential promises to bring to more young men the care that they deserve!
Paul Turek MD
Endowed Chair and Professsor
Department of Urology
Director, Mens Reproductive Health Clinical Research Center
University of California San Francisco
Advisory Board Member, Genosis Inc.
First of all, Dr. Turek, as a physician and educator, is one of the most highly respected and well-known experts in the field of male fertility and andrology. Paul has been instrumental in raising awareness of the essential role of the urologist in the evaluation of the male when assessing a couple’s fertility.
Dr. Turek and I agree, but I think we are looking at this from a different point of view. Let me make this clear. I like the idea of an accurate home test. This will be great for my patients. As I read Dr. Turek’s comments, he believes (and I agree) that this home semen analysis test will bring attention to the male fertility issue, giving men motivation to seek out additional urologic attention. I would hope this indeed is the case, though I have my concerns. I worry that this hope test may lull some men into thinking that they are okay and so will not seek out further male fertility evaluation. My guess is that both will be true. These results are just one piece to the puzzle. For some, this test will raise questions that need to be answered and drive them to the urologist. Others may misinterpret the purpose and results of this test, believing that they do not need to seek out urologic evaluation. Information is indeed power. But only with accurate and reliable information can patients make intelligent and informed decision about their health care.
My experience with men in a community referral practice may be totally different from Dr. Turek’s. Perhaps in an academic teaching center setting, Dr. Turek’s patients are self-selected and more motivated.
Here’s the bottom line concern - will this home semen analysis test be an instrument of motivation or justification for avoidance?
But let’s first look at the current problem with fertility as it relates to the male psyche. Okay, guys are guys. For the most part, men resist going to a doctor even when something serious is going on. In fact, many men die because they just will not seek medical attention. Yes, things are changing but still the majority of men do everything in their power to stay away from doctors. That is just the way we are. I firmly believe that most men go to a doctor only when their wives force them to do so. Look at all the men who use their grocery store cholesterol check or a free prostate screening as their “doctor’s visit” and justification for not seeing a doctor for a few more years. We live by the philosophy of active avoidance.
Add on top of that the guilt factor. If a couple is having trouble conceiving, the last thing a guy wants to find out is that he is the one responsible for the problem. That is the ultimate attack on a man’s ego- that he is subfertile or totally sterile. That’s the last thing that any guy wants to know. Might as well just paint a big green letter “I” on his forehead so everyone will know he is infertile. Totally devastating, to say the least.
Let’s then look at the state of male fertility in the US today. Even though male factor plays a major role in fertility issues, the urologic /male aspect has been totally bypassed in the vast majority of evaluations. In the community, this is a crisis. I don’t know about in the academic world, but out here in the trenches, most couples seek out a urology evaluation after IVF fails. All urologists, especially the leaders in male fertility such as Dr. Turek, have been fighting to get the urologist included early in a couples’ fertility assessment, as it should be. I would never pretend to be able to do a detailed female fertility evaluation nor would I expect a reproductive endocrinologist or OB to do a male fertility assessment and exam. And we all know and agree that male factor is critically important, and can often be improved. Having a urologist as part of any fertility evaluation is an essential early part of any couples fertility work up. We are making some headway. But the main problem still remains- patients are being funneled directly from no baby straight to IVF, with no male assessment. “Bypass the urologist because we can make a baby without his input or help,” they justify. Then you bring on a new kit. Wow. Easy to use, quick, private. Tells a guy whether he has 10 million motile sperm or not. The perfect answer. But is it?
Let’s look at possible scenarios. In one, the man’s counts are not good enough to light up the probe. He does not have ten million motile sperm in that specimen. I fear that many will use this abnormal result to justify fast tracking straight to IVF. “Hey - his counts are low, so low that IVF is the only answer.” What about potential cancer, environmental, occupational, medications, hobbies, or other correctable male factors? Will they go see a urologist and get formal semen analyses as they should? If they do as instructed then they will see a urologist. That is the intent, though sadly, I can foresee many men stopping here.
What if the test shows his counts are normal at 10 million motile sperm. Is that the answer? No, as Dr. Turek will tell you, there are so many other factors that can play into male factor fertility or infertility. But again we are dealing with men. They will say “I have done my share- I have proven I am fertile”. Reassured that they are still the man they want to be, they might tell their wives, “hey, the work up is done. I am fine. It is your problem now… you go see the female fertility/IVF doctor.”
Of course the goal is to get more men to check their sperm counts and if they are not normal, then to seek out appropriate urologic evaluation. And for many, this will be the case. I hope Dr. Turek is right and this will spur more couples to consider male factor as a contributing role in their infertility. In the ideal setting, this test should increase our role as male fertility experts involved in all couples infertility evaluations. This kit should increase all couples’ awareness of the male factor role. I plan on recommending this kit to many patients. But now more than ever we need to accelerate this crusade to be sure that male fertility experts are involved early in all couples fertility evaluation. It is what’s best for the patient. As it should be. As it needs to be. Only time will tell.
Dr Marks has thoroughly explained his view on the issue of the recently introduced male and female home fertility kit called Fertell.
As he has stated, I worry tremendously about the fact that most male partners in infertile couples do not undergo any evaluation for the cause of infertility, unlike the women. Because of this, assisted reproduction, especially in the form of IVF and ICSI, has hurt more than helped men's health in the US.
With blogs like this one and proper publicity devoted to it, it is our responsibility as care providers to let patients know that this kit does not "clear" a patient from further urologic evaluation, but is simply a screen for sperm quality. However, it is far more likely that a man with abnormal semen quality will have a medical condition that needs treating than will a man with normal semen quality. We even have data being published that an abnormal semen analysis is a true "window" into the future health of that individual. This field is just getting larger and larger and the US is far behind some European countries in this regard.
So, the potential of the male Fertell test to increase the number of men getting ANY KIND of evaluation for infertility whatsoever (a good thing) in my opinion outweighs its potential for neglect ("I am normal since the kit is normal"). I am hoping that the female partner will help the male to follow up on the kit results by simply ASKING QUESTIONS of their care providers and get the answers (and the care) they need to be able to navigate their way through the difficult and often devastating problem of infertility.
Paul J. Turek MD
Endowed Chair and Professor
Director, Men's Reproductive Health Clinic and Research Center
UCSF
Advisory Board Member, Genosis Inc
I am glad Paul has taken the time to share his thoughts. As he pointed out, the bottom line is that all men involved in fertility assessment need a urologic evaluation as part of the couples assessment. There is no rational excuse for excluding the man from evalution.
I have followed this discussion with some interest. I too am primarily a community based male infertility specialist, with a part time academic practice so i have a foot in each camp. I believe both Dr Marks and Dr Turek have valid points and ultimately I share thier overriding viewpont that men in infertile couples are underevaluated and undertreated. I do hope that the Fertell test will bring awareness to more couples that their infertility isn't just the woman's fault, and this will bring more men to appropriately seek evaluation and treatment from the male fertiltiy specialists they require. I am worried however by the wording of the materials that accompany the test which ultimately may unnessesarily delay a subset of these patients from comming to see the specialist in a timely manner. Specificly the following text :
"If the results indicate that your concentration of motile sperm and FSH are within normal levels, then you should continue trying to conceive.
You should contact your physician’s office if the female:
is under 35 and has been trying for over 12 months
is 35 or over and has been trying for over 6 months
has had no menstrual discharge or has irregular intervals between periods.
For example, you are 33 years old and have been trying for 2 months when you took the Fertell test. You should try to conceive for no more than an additional ten months before contacting your physician if you are still not pregnant."
The problem here is that there are men with "normal" total motile sperm according to this tests threshold of 10 million motile sperm who may yet have conditions rendering them subfertile. These include but are not limited to infection or inflammation in the semen, antisperm antibodies, disorders of DNA integrity, and low volume. The threshold of 10 million motile may be achieved by a male who is nonetheless declining from a higher baseline due to a progressive deteriorating condition such as varicoceles, or due to a newly emerging testis cancer, or pituitary disorder. 10 to 12 months may be too long to wait for this to be discovered! Ultimately there is nothing wrong with information, but i worry how the interpretation of that information is being conveyed to the consumers of this product by its manufacturer.
Aaron Spitz MD
Assistant Clinical Professor
Department of Urology
University of California, Irvine Medical Center
Great Blog!
This drives home the point that do it yourself isn't always the best. In my business of financial advice, trying to do it yourself at home can often cause more harm than good. The same seems to hold true here.
Thanks for the interesting read.
FROM MEG
I AGREE, HOME IS NOT ALWAYS THE BEST - I AND MY HUSBAND BELIEVE, YOU NEED TO GET ALL THE INFORMATION AND GET ALL THE THE INFORMATION TO YOUR DOCTOR - "LIKE PEEING ON THE STICK", YOU STILL NEED ALL THE INFO.
Gentlemen,
Very interesting blog with valid and important points. As a matter of ethics, would you please comment or clarify your contribution or any financial connection to the product in question?
Thank You.
Seems to me that the real concern here is the welfare of the person/patient. Taking the full evaluation out of the picture (making this possible) and leaving so much to folks with very little if any medical background and so much emotional concerns at issue seems a bit unfair. I too would like to know who is really to benefit from this test. Perhaps the true battle lies in the manufacturer over patient benefit. I do worry. I'd prefer the patient in the doctors office versus their own bathroom.
Perhaps with only value to these home tests is to feel like you're doing something (perhaps to keep the woman happy). Dr. Marks brings up some good points. Often a symptom, in this case poor fertility, is really due to something else - some medical condition that needs to be identified and treated. As a physician, I see this happen often.
it is agood step to man to begin to moove early but negative test man my be depressed early and sometimes low count slow movement sperms my fertilize women egg they will be affected psychologicaly .... sot that test should done after one year marriage without pregnancy
DR.MOHAMED AHMED GAD EGYPTIAN PHARMACIST
In repsonse to the question, I have no finacial interest or investment of any kind in this product. I like what it can do for my patients as a vasectomy reversal doctor- to be used as a tool in addition to standard formal semen analyses tests to follow patients after their reversal. There is no question that providing or delivering a semen specimen to an 18 year old cute coed at a lab desk is awkward and for most men, embarrassing, so I do still worry about this test being given too much "power." It is a great first step but we cannot stop here. We need to get our colleagues in primary care and OB to understand and accept the role of the urologst in all infertile couple's evaluation before anyone even talks about IVF.
At a glance this new product sounds wonderful. What man wouldn’t rather stay in the privacy of his own home to find out if he is fertile or not? Working in an andrology lab has shown me how hard it is for men to undergo the simple physically painless semen analysis to check male fertility. Most often it is the wife that sets up the appointment and lets the husband know when to show up or drop off the sample because of the agony that goes along with the questioning of a man’s fertility. This new product could lead to high hopes just because the total motile sperm count looks good. However, there are a number of other factors that play into the role of how good a semen sample may or may not be. I always recommend having a semen analysis done by an andrology lab who has trained individuals to look at all parameters involved with a semen sample to get a more in depth idea of actual fertility potential. If a couple is having fertility problems it is worth the time to have fertility workups done for both the male and female involved. The idea behind this new home test kit is a great start but in all reality seems like an incomplete answer to a possible underlying fertility problem and most doctors would most likely recommend a full semen analysis done by an accredited laboratory to know the best direction to take in treating a couple’s infertility.
Amy Perkins, MS
Laboratory Supervisor
Arizona Andrology Laboratory & Cryobank
I am urologist with focused interest in male factor fertiliy with both comminity and academic ties. The Fertell kit overall is great addition to men's health. I, however, have serious concerns regarding their rather detailed "doctoring" advice. I am of the camp the male factor fertility is often ignored and deliberately bypassed by non urologists treating the men and the men themselves not wanting to go through this type of evaluation. For this test to not be another source of misinformation, the package insert interpretations needs to be far more vague and less interpretive. (I have no vested interest in this product, although I wish I did)
Peter Burrows, MD
to continue the conversation
would you consider freezing your sperm for future use?
http://www.pollsb.com/polls/poll/1004/would-you-consider-freezing-your-sperm-for-future-use
Can any of the doctors here recommend a good TECHNICAL and moderately accurate book on the subject? I and not afraid of medical jargon and would like to learn more.
It is especially interesting as the field of bio-physics emerges and is growing.
I would imagine the physical and bio-chemical quantification for fertility metrics, has to be an interesting area of of study.
Thank you,
Physics Grad Student
University of Colorado,Boulder
Thank you,
We have surveyed the initial US purchasers of Fertell and at least one result can only be viewed as very beneficial; the product has identified many people who may have a fertility issue and the vast majority of them (88.3%) report that as a result of Fertell they have or are going to see their doctors for further evaluation. Of the small number that has not contacted their doctor yet, all have been trying to conceive for more than 12 months. Regardless of the test results, Fertell’s package and literature stress that both the male and female need to contact their doctor according to the current clinical standards (typically after 6-12 months of trying depending on the female’s age). This indicates that this latter group’s reluctance to see their doctor results from factors beyond the capability of any test. Of greater importance, among those who are now going to see their doctor, many had delayed well beyond the timeframe of the clinical standards.
Clearly Fertell has begun to demonstrate its potential value for couples trying to conceive but I believe that Dr. Marks is prudent to warn consumers to not abuse Fertell’s results as an excuse to not contact their physician within the appropriate timeframe.
Robert Thompson
President
Genosis, Inc. (Makers of Fertell)
If you don't mind, I could use some intelligent insight. I have been trying to conceive for close to a year. I will be 35 in a few months. My husband has taken anabolic steroids and I am quite sure this is our hold up. He has been off of them for almost 4 months now and has been taking supplements to hopefully expedite the situation. He was off of them and then went back on for a month back April, unaware that the negative effects were long lasting. He assumed the effects were only while you were taking them. I am aware of all of the reasons why he should not take them. Believe me. That aside, will the Fertell kit help me establish if his sperm count is back up to normal and/or the motility? He actually asked me to look into a test so we can figure out if the problem really is him or if it may be me. I am ovulating regularly, at least according to my Clearblue Easy Fertility Monitor. I am unsure whether or not to engage in this conversation with my doctor next month but feel she needs to know in order to help me. The issue of steroid use is a sensitive one and I am concerned about saying too much. I am desperate to have a baby and was naive to the effects of his steroids (minimal amounts). I was very unprepared for such a struggle.
I greatly appreciate any information any of you can provide me.
I greatly appreciate the information being posted. I would like to pose this question to the Dr's.
I am a single man, age 43. I don't smoke, rarely drink, very active and healthy. I do want to have a child someday. I have thought back on past relationships with some curiosity regarding the lack of ever having become a father.
For about a year I have been wondering if I was the denominator that was out of range.
If one really wants the total answer to where he stacks up regarding his chances of being a positive influence in conception, is this test a logical step to take? I guess what I'm asking is; if I took the test and found my number to be very low, are there treatments I can pursue to effectively change my situation or does that have little hope?
I have no problem visiting the Dr’s office to have the testing done… I intended to go anyway. I only found out about this product from a friend… interestingly enough, we used to date, had dinner last evening and after dropping her off at her home she tore the ad from the back of a magazine and mentioned that she immediately thought of me when she read it. Lucky me!
Thank you in advance for the information…
First, I wanted to thank everyone who left a comment. My husband and I have been trying for a year to conceve, but have been unsuccessful. We have talked to the doctor and are starting some testing. This test sounds like a good thing for us and we will be trying it out. I think it might help us understand what could possiably be going on. I like to know what the possibilites are before I make choices. This home test will give us some information that may help us understand more if we are able to use it. Since fertility is not considered a medical necessary it is not covered much by insurance. My husband and I's insurance does not cover this. If its going to help us understand what is going on in our bodies and help with some of the cost it would help us greatly. IVF is not something that we want to do because of the cost...but maybe this test can really help us make knowledgeable decision.
Thank you for your comments
I just spent 30 minutes writing something very apropo about Fertel and my experiences but I'm afraid it got lost.
The short version: Thank you to Dr. Spitz for your compassionate and resourceful help regarding my husband's 'subfertility'. We used Fertel, got a negative result on his end, saw a couple dr.'s who were really of no help when my husband found you.
We found out in reality he wasn't subfertile at all. Using this kit caused us undue stress and I am sorry I ever made him use it. Go to the Dr. and get some answers for now AND your future. That is something Fertel can't offer.
As a teacher, I believe knowledge is power but sometimes knowing just enough can make you dangerous. See a Dr that has your interests in mind instead. Skip the Fertel. Also, Dr. Spitz, I am 6 weeks pregnant. Thank you again for rescuing us and giving us the hope necessary to keep trying. Conceiving is just not as black and white as Fertel makes it out to be.
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