At-Home Sperm Tests Have Value But Limitations

England's King Henry VIII is sometimes referred to as the "father of the Royal Navy," but what he's usually remembered for are his repeated—and violent—efforts to father a son. The circumstances with which Henry replaced a succession of six unfortunate wives might have turned out differently had they known then what we know now about fertility.

You can imagine Henry's fourth or fifth bride saying, "Henry, buddy, this is clearly a you problem, not a me problem."

Modern couples who are having trouble conceiving have many ways, including home sperm test kits, to start learning about possible issues and causes. These kits are relatively cheap and readily available, but it's crucial to understand what they can tell you—and what they can't.

Infertility is everybody's problem

After a year of unprotected sex, 12 to 15 percent of couples can't conceive, according to the National Institute of Child Health and Human Development. After two years, 10 percent still haven't produced a live birth. That's in contrast to the 40 to 60 percent of healthy couples younger than age 30 who can conceive within three months.

"We know that infertility is a couple's disease," said Neel Parekh, M.D., a male fertility specialist in the urology department at Cleveland Clinic. "However, men are more hesitant to seek medical evaluation as compared to their female counterparts."

But given that the man's genetic material is abundant and, er, on hand whenever you need it, many couples start to search for answers with a home sperm test kit.

"If a couple is proactively trying to assess their chances of conceiving a pregnancy, a home sperm test can be a useful first screening tool, similar to a woman tracking her ovulations using a smartphone app," said Sriram Eleswarapu, M.D., assistant professor of urology at the Men's Clinic at UCLA. "They're a reasonable entry point for men who are curious about their overall fertility potential, and for men who don't have easy access to a reproductive urologist or clinical lab."

What a laboratory sperm test shows

The viability of a man's sperm is determined by a number of factors, and when something goes wrong with any one of them, it can hamper his ability to father a child. A professional laboratory test can tell you about:

• Semen volume, or the amount of ejaculate
• Sperm concentration (also known as sperm count), or how many sperm are in a given volume of semen
• Total motility, or whether the sperm are moving at all
• Progressive motility, or whether the sperm are moving forward or just twitching in place
• Morphology, or the shape of the sperm

Home sperm test kits aren't nearly as comprehensive.

What about those home sperm tests that make claims such as "97 percent accuracy"? Those claims are often glossing over what the tests are actually measuring.

Eleswarapu addressed one popular brand's quote of 97 percent accuracy.

"[The test] reports whether the total motile sperm count—that is to say, sperm concentration multiplied by total motility percentage—falls above a threshold minimum," he said. "This information is useful but incomplete. Other home sperm tests report estimates of sperm concentration and can reassure a man that his counts are normal, but this information omits whether the sperm are healthy, moving, normal in appearance and so on."

Other information the home test can't tell you: causes of poor sperm quality. Sperm may not be up to snuff for a number of potential reasons, many of which won't be identifiable from a simple home sperm test kit.

"Varicocele is the most common and correctable cause of male infertility, with a prevalence of 40 percent in infertile men," Parekh said. "There is also evidence that oxidative stress [when toxifying free radicals overwhelm your antioxidant defenses] plays a large role in affecting sperm quality. Environmental/occupational exposure to toxic chemicals and various lifestyle factors, such as smoking, alcohol, drug abuse, obesity and psychological stress, are all potential risk factors of male infertility and can exacerbate oxidative stress."

So home sperm tests leave out a lot of information. But while you'll need an exam by a healthcare provider to determine the underlying cause of poor sperm quality, most clinicians say the kits can provide value in one way: getting the process started.

"Anecdotally, I see the most benefit when a patient does a home sperm test and the result is abnormal," Parekh said. "I don't spend much time trying to find out the exact results of the home test. It gets the patient in the door and allows me to do a full history and physical exam. I will then order a formal semen analysis."

As both Eleswarapu and Parekh point out, the home sperm test kit is a logical first step for couples who live far from a clinic with andrology facilities and fertility specialists. Even reluctant men are more likely to do the test in the privacy of their home, and troubling results may help push them to get professionally evaluated.

What's more, looking at the man's side of the equation first can potentially save couples a ton of trouble and expense.

"The home test may be a more comfortable experience and can trigger further evaluation with a male fertility specialist, if needed, or avoid the female going through unnecessary treatment," Parekh said. "For example, I have had patients where the male was never evaluated, and the female underwent much more testing, expense and treatment than was necessary."

And, hey, if Henry VIII has taught us anything about fertility, it's that both partners should be evaluated.