Wednesday, May 11, 2011

Fertility Testing At Home: Home Sperm Testing

Over the past few years more and more fertility tests have become available for home use. This month one of the leading journals in the fertility world, Fertility and Sterility, published a very nice review of many of these home tests. Coincidentally, I just gave a talk about many of these tests and thought I would share my thoughts about them.

For the sake of time and space, I’ll tackle these one at a time. Today, we’ll talk about home sperm testing.

Before we get there, let me give some background.

The idea of home testing fits a definite need among consumers. It’s nice to be able to learn that you’re pregnant without making a doctor’s appointment. It’s also nice to identify problems early, if that leads to evaluation and effective treatment.

The problem with a lot of tests on the market is that they can be falsely reassuring and may cause some people to delay proper evaluation. There is no good evidence that performing such tests actually improve a couple’s chance of conception. A patient without a history of infertility is most likely wasting their money. On the other hand, if a couple has not conceived within 1-2 years of unprotected intercourse, I’m not sure that any home test is particularly reassuring. A falsely reassured patient may delay treatment and therefore is at risk for not meeting their reproductive dreams.

Several years ago after hearing a story about home fertility testing on NPR’s All Things Considered, I wrote a letter describing some of the pitfalls to such testing.

The two tests described where a semen test and a test to measure a woman’s FSH, marketed under the name Fertell (Genosis Ltd).

The Fertell sperm test can determine if a man has 10 million total motile sperm and is sold for close to $100. The advantage of this test is that many men are embarrassed to have a formal semen analysis performed. Also, the test determines the motile concentration, which is fairly predictive of normal fertility. Recently, the World Health Organization (WHO) published findings showing that 95% of fertile men had a sperm concentration of 15 million sperm/ml and 32% were progressively motile and 5% or more had a normal shape. A reassuring Fertell tests should correlate well with 2 of those 3 parameters. If abnormal, the test should lead a man to have further testing performed.

The drawback to the Fertell sperm test is that it does not test morphology, which can be very important. The cost is also a drawback. For an additional $50, a patient can have a full semen analysis at our clinic and have it interpreted by a physician who can interpret the results in the context of the couple.

Other home semen tests are also available. Embryotech has marketed several tests FertilMARQ, Start Male Infertility Test and PreConceive: A Male Fertility Sperm Test, all of which purport to evaluate sperm concentration. Because it tests only a single parameter (concentration), it tells nothing about motility or morphology. A man with few or no moving sperm may be falsely reassured. (As with the Fertell test, an abnormal result should be followed up with a visit to a physician’s office.)

There are also small microscopes available: The disadvantage of this test is that interpretation is left up to the patient. As with all home testing, the disadvantage to the home microscope is that there is no one with clinical experience to interpret the test in the context of the couple.

One of the tenants of good medical practice is to treat the patient, not just the test.

As I said above, a normal test does not mean that all is well. A person without infertility may find this test reassuring; however, this person probably doesn’t need the test in the first place. A full semen analysis gives significantly more information than any of these tests. A couple with infertility is probably better off having a medical evaluation by a knowledgeable physician. However, if the only way to get a man to get tested is with at an at home test, I would pick Fertell since it gives the most information with the easiest interpretation.

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