Natan Bar-Chama, MD
Natan Bar-Chama, MD, director of male reproductive medicine at at Mount Sinai Medical Center in New York City and director of the Center for Male Reproductive Health at Reproductive Medicine Associates of New York (RMA of NY).
Hey, men—how would you like to buy a cheap kit at your drugstore that quickly tells you whether your sperm are up to snuff?
The kit is supposed to help couples figure out whether the man is the reason that they are having trouble getting the woman pregnant.
Up until now, the only way to have your sperm checked was through a doctor—you’d have to make an appointment to discuss your fertility concerns, the doctor would order a lab test, you’d provide a semen sample, and then about one week later you’d get the results of a thorough examination of your sperm’s quantity and quality. The test would cost anywhere from about $40 to $200 and would sometimes (but not always) be paid for by health insurance.
The new drugstore sperm test, however, costs about $40 and gives you results in about half an hour.
But can a simple home test really measure up to the kind of thorough screening that a doctor can provide? Some physicians are voicing concerns about this new product, so I called an expert in the field to get his take on the controversial new test.
The new over-the-counter test is called SpermCheck Fertility (SCF). Starting this past April, it’s been available online at sites such as CVS.com and at drugstores such as Walgreen’s. To use the kit, a man ejaculates into a container, waits 20 minutes and then (using a tool) adds a sample of his ejaculate to a chemical mixture and lets that stand for another two minutes. Then he places drops of the mixture on a test strip, waits another seven minutes and reads the strip. If the strip produces a red line, the test suggests that his total sperm count is likely in a “normal” range. If the strip stays bare, the test suggests that his total sperm count is likely in an “abnormal” range and may be contributing to the couple’s fertility problems.
To get an expert’s opinion on the test, I called male reproduction specialist Natan Bar-Chama, MD, director of male reproductive medicine at Mount Sinai Medical Center in New York City. “I am pleased that it helps couples focus on the potential for a male contribution to infertility, which is the case in one out of three infertile couples” Dr. Bar-Chama said. But then he pointed out the test’s major flaws.
Dr. Bar-Chama said that assessing only how much sperm per milliliter is in a small sample of the semen, which is what SCF does, does not accurately determine a man’s total sperm count (the entire amount that is in his full ejaculate—not just a sample). The semen volume must also be measured, said Dr. Bar-Chama, because semen volume can vary from man to man.
For example, one man might regularly ejaculate just 1 ml of total semen, while another man might regularly ejaculate as much as 5 ml of total semen, said Dr. Bar-Chama. A sperm count of over 40 million total sperm is considered “normal.” So if both men provide a sperm sample that contains 10 million sperm per ml, then the person with only 1 ml in volume would have a low and “abnormal” total sperm count of 10 million, while the man with a volume of 5 ml would have a total sperm count of 50 million, which is high and “normal.”
When a man sees a doctor for a full semen analysis, semen volume is measured. But SCF doesn’t measure semen volume—it estimates that a man’s semen volume is at least 2 ml, so if the test shows that a man’s reading is under 20 million sperm per ml (and therefore, under a total, normal sperm count of 40 million), then the test considers that result “abnormal.” Dr. Bar-Chama’s concern is that men might get “abnormal” results from this test when they’re actually fertile and vice versa.
So not measuring semen volume is one reason why SCF fails in Dr. Bar-Chama’s eyes. But that’s only the tip of the iceberg. There are two other major factors that a doctor measures but SCF doesn’t…
Motility: What proportion of sperm are active and swim fast and straight? Slow-swimming or nonmoving sperm are unable to travel through the female reproductive tract and fertilize an egg.
Morphology: What proportion of sperm are shaped normally? If sperm are shaped oddly, they are hampered in their ability to fertilize the egg properly.
So instead of using this over-the-counter test, Dr. Bar-Chama advises all couples who are infertile (haven’t achieved a pregnancy after one year of trying) to go to a fertility specialist so both the man and the woman can get complete evaluations.