How Accurate Are At-Home Fertility Tests for Men?

At-Home Sperm Tests Can Provide a Useful Starting Point

Interviewer: If you've ever been in a pharmacy aisle or scrolled past an ad for an at-home sperm test, maybe you've wondered, "Does that thing really work?" Well, this conversation is for you. We're going to talk about what those tests really measure, more importantly what they miss, and what to do if you want a complete picture of your fertility.

Dr. John Smith is a physician who trained in family medicine, then he went on to complete a fellowship in genitourinary medicine. He brings a whole-person approach to urology.

So at-home fertility tests... a lot more visible, and I'm talking about for the men. You can get them at a drugstore, you can get them online, get the results on your phone. How much has this category actually changed in the last few years from your perspective?

Dr. Smith: I mean, there's a lot more. If you look at the space with these types of tests, as well as men's health online, there's been a huge jump in the number of companies that are out there doing this. Not a huge jump. I mean, there are more and more, and you've probably seen ads for different stuff for men's health side of things, erectile stuff, all those companies in the similar vein of fertility.

There are all these companies because fertility can be very expensive because it's often not covered by insurance. If you do have insurance benefits, it's usually a dollar amount where they're like, "We'll pay $5,000 for your fertility. And after that, you're on your own," kind of thing. And so there's a big market for these folks to kind of bring some value for the dollar there before you get into the big money.

Interviewer: Right. So I think you've just kind of answered one of the questions that we can dive in deeper. It sounds like what they do is they kind of give you a cursory, broad view. They're not really super specific. They're kind of the thing you do before you go maybe to get a deeper dive.

Dr. Smith: Sure.

Interviewer: Are they all pretty much the same? There are a lot of different ones out there. Is one better than the other, or are they all kind of the same?

Dr. Smith: Nobody sponsors me for this, but I think there are some that are more reputable than others. We see quite a few of these come through, and people come in and ask. The one I've seen that I think is pretty good is one called Fellow. Obviously, I'm not endorsed to say that. I just know that in talking with my colleagues who do a lot of fertility, a few of them mentioned that one by name.

Interviewer: That's the one they like, huh? What makes it more reputable?

Dr. Smith: Well, they've seen the results. And I think the folks who kind of back it. . . I mean, if you scroll to those folks' website, they usually have some folks they've partnered with. You'll usually see some medical schools or some andrology folks that are reputable on there. You'll see on their web page where they're like, "We work with UCSF and USC and Stanford and Yale," and those types of things where you'll see these folks like, "Hey, we've partnered with these folks to make sure we've got a good product out."

I think that's one of the things because those folks tend to lend a little bit more reliability and a little bit more comfort when you're looking at these products.

Semen Analysis Measures Sperm Count, Movement and Shape

Interviewer: Right, because you want good information. So for somebody who's never used one, what are the tests actually doing? What do they measure?

Dr. Smith: In essence, they do the same thing that you would do when you go to. . . Say you come to our office and you come in and you sit down with me and you say, "Hey, we're looking at fertility." And I go, "Okay, great. I'm not a fertility specialist, but I know how to get you started. We'll do the workup initially to make sure that everything looks good. And if your sperm counts look good and everything looks good, then we may want to get your partner checked." That kind of thing.

And so getting a semen analysis is what it's called. You give a sample, and in that sample it looks at how many sperm are there in a quantity, how many sperm million per milliliter, how many are there total in your sample, how many of them are motile and moving, how many of them are moving in the right direction, and how many of them may be misshapen or have what we call morphology changes. 

And so all of those things can have an effect, some more than others, but those are the things that we kind of look at in a general semen analysis, and these companies are doing the same thing.

A Normal At-Home Test Does Not Guarantee Fertility

Interviewer: Got it. So how accurate are they? If you get a normal result, can you trust that? 

Dr. Smith: Yeah. I mean, obviously they wouldn't allow them to be on the market if they weren't accurate. A lot of the research will show that they're 95% accurate to 98% accurate when compared with other tests. The FDA clears these tests to be done, and so there is some validity to them. So I wouldn't pooh-pooh them. Like I say, I think there's a role for them.

An Abnormal At-Home Test Does Not Always Mean Infertility

Interviewer: So if somebody gets an abnormal result, does that mean that there's definitely a problem then?

Dr. Smith: Not definitely, but decent likelihood. I mean, these things, again, 95% to 98% of the time they give you a good result. So majority of the time, those folks are going to come in, and they're going to have something that we likely need to look at and evaluate further.

Interviewer: Yeah, that gets you started a lot faster if you've got that information when you go in. 

Dr. Smith: Absolutely.

Interviewer: Probably the less desirable outcome, at least from my perspective, would be like, "Oh, this came back, everything's normal, but we're still having trouble. That means there's probably something else going on." So what aren't they measuring? What could they miss that you might catch then?

Dr. Smith: Right. So there are some other genetic things you can order and have done to look at things like Y chromosome deletion or different other things that are out there that won't show up on a semen analysis. DNA fragmentation, things like that, that are out there that may not be showing if you have normal levels and you're still not getting pregnant.

Both Partners Should Be Evaluated for Fertility Issues

And the other thing you've always got to keep in mind is, at the same time, I usually recommend if you're having fertility issues, both partners get worked up. Fifty percent of these end up being each partner. It's a 50/50 shot. Men have responsibility for fertility issues half the time, and women as well. So make sure you and your partner are both getting checked out.

Interviewer: And when you say 50/50, you're not just being cute, that it takes two to tango, right? Legitimately, research supports that 50% of the time the issue is the man, 50% it is the woman.

Dr. Smith: Correct. And you are correct that it takes two to tango as well, but I was not being tongue-in-cheek there.

Follow Test Instructions Carefully for the Most Accurate Results

Interviewer: All right. If somebody's going to use one of these tests, what would you tell them to do to make sure they're getting the most accurate result possible? They're trying to save money, so let's make sure that this thing does the job that we want it to do.

Dr. Smith: So, in general, when we ask people to do semen analysis, we ask them to abstain from intercourse/ejaculation for a couple of days to make sure that they have a good quality test.

And then ultimately, if you're in the fertility journey and you're looking in that direction, just make sure your general health things are going well as well. Make sure you're eating well and doing just the basic stuff that you would think of: eating well, sleeping well, and maintaining your health best you can.

Interviewer: Right. Sometimes on the instructions, it also talks about temperature, timing, not using lubricant, those sorts of things. Are there other tips that you have? I would imagine read the directions first of all, because the directions are going to tell you how to get the accurate result. I would imagine some guys kind of just do it, right?

Dr. Smith: Yeah, you definitely want to follow the instructions.

Interviewer: Sometimes we're not the best at reading directions, are we?

Dr. Smith: Yeah. And when we have folks go into, say, the andrology lab here at the University of Utah, we have them call, and they get instructions to get it there. If they're going to donate at home, it has to get in within a certain amount of time.

And then lubricants, things like that, things with spermicides, different things that can kind of change the pH of that and make it less reliable or damage the sperm; obviously you want to avoid those things. So definitely follow the instructions.

Interviewer: Got it. And what about testing more than once?

Dr. Smith: I think that's the reasonable thing to do if you're concerned about your test at all. But in general, if you follow the instructions, you have a good test, you can generally rely on those results like we mentioned before.

Hormones and Varicoceles Require a Clinical Evaluation

Interviewer: All right. Well, let's talk about a clinical evaluation. So we do the test, and regardless of what it comes out saying, at some point you're probably going to need to involve a clinician. So what is a real evaluation?

And when I say real evaluation, I should be a little bit more specific. What does an office evaluation look like when somebody comes to see you? What can you learn that the home test can't tell them?

Dr. Smith: So your home test isn't going to check hormones. It's not going to check for an anatomic abnormality like a varicocele, which is a varicose vein in the scrotum that can increase the temperature and decrease your sperm counts or decrease the quality of the sperm. Things like that you're not going to get evaluated or have somebody look at when you do those home tests.

And so those are things that can be important if there are derangements in hormones or there are those anatomical abnormalities that would need further evaluation. Those are things that are going to get missed by just doing an at-home test.

Interviewer: And if somebody's listening, did get that abnormal result, and they want to take the next step, can they just make an appointment with University of Utah Health Urology, or do they have to have a referral, or how does that usually work?

Dr. Smith: Depends on their insurance. I mean, a lot of times folks can just make an appointment there, but some insurances require you to get a referral over to our office. Either way, just kind of look at what the requirements are for your specific insurance.

Obviously, the fertility market is much likely a cash-pay scenario. And so we try to make it as open as we can for folks to get in and see us. We always try to help out the best we can and use insurance when we can, but a lot of this testing and stuff does end up coming out of pocket, which is tough.

If you do want to make an appointment, just reach out, and we can do our best to get you in and make sure you're taken care of.

Male Infertility Has Many Treatable Causes

Interviewer: And if something is found, are most causes of male infertility treatable?

Dr. Smith: A lot of them are; certain things like azoospermia, where you don't have any sperm whatsoever. But if folks have sperm in a test, we can usually help folks out. Sometimes it requires procedures, different things, in vitro fertilization, and all the things that go along with that. But there are ways of making it happen. And we always say, "Hey, we'll do our best to evaluate everything completely before we give you an ultimate news."

Interviewer: And I'd imagine you also are very sensitive to the fact that this can be an expensive process.

Dr. Smith: Oh, of course. And this is a tough one too because you're wanting to have a child and it's this dream and all these things. We love to make sure that we take care of things and make sure folks are at least evaluated in a proper manner. And we look at things from an appropriate perspective and look down the avenues that are going to be best to help achieve the goal of fertility.