Getting Tested: Options for Testing Sperm

Because male infertility has no outward signs or symptoms, the only way to find out if there is an issue is to have your semen tested. There are several options available for home testing as well as a variety of techniques used in labs.

<<  Topics Getting Tested | Semen Analysis

Getting Tested

Because male infertility has no outward signs or symptoms, the only way to find out if there is an issue is to have your semen tested.  There are many options for testing male fertility both at home and at the doctor’s office. Learn what is measured in semen analysis, how much it costs and what to look for.

Finding a Doctor

No matter which testing option you choose—a home test or a full clinical analysis—it is important to discuss the results with a doctor. It is appropriate for men and women to see different specialists, and finding a male fertility physician can be a tricky task.

Women traditionally visit an OB/GYN, who may refer them to a fertility clinic staffed with Reproductive Endocrinologists, many of whom are OB/GYNs with two additional years of training in fertility. These doctors are experts in understanding the female hormone cycle and causes of fertility issues in women.

On the male side, fertility issues are commonly handled by urologists. These specialized surgeons commonly perform vasectomies and treat prostate problems. Andrology is the sub-specialty of Urology that focuses on reproductive health. Unlike on the female side, there isn’t a board certification program in Andrology, so it is harder to find male fertility specialists. While all urologists can run the basic tests of semen analysis and physical exam, it is important to contact a specialist if there is an issue. Some male fertility issues are plumbing problems that can be resolved with corrective surgery by a urologist. Others are related to hormonal imbalances, genetic conditions, or other causes which general urologists may be less confident diagnosing or treating. A fertility specialist sees all sorts of cases, and can treat a diverse range of problems.

Many of the leading researchers in male sexual health have found significant links between poor semen quality and general health conditions such as cancer, heart conditions and diabetes. For this reason, a fertility specialist will review your lifestyle, medical record, and family history to get a more complete understanding of your overall health and possible risk factors.

Beyond finding a specialist, it is important to find a doctor that you feel comfortable with. See Doctors for a list of male fertility specialists.

Male Fertility Testing Options

A full male fertility workup includes recording family history, performing a semen analysis, conducting a physical exam, and occasionally other tests. Blood work is used to test hormone levels, ultrasounds diagnose plumbing issues, and genetic tests identify conditions that may degrade semen quality. The main test is the clinical semen analysis, which provides a great deal of information on the quality of the sperm. In recent years a number of home testing options have come onto the market to help couples do some initial screens in the privacy of their own homes. The following review explains how clinical and home tests work and what kind of information they each provide. Regardless of which testing option you choose, it is a good idea to follow a few steps to prepare so that you get the most accurate results.

Clinical Semen Analysis

Cost: $100-300 plus consultation fees

How it works: A semen analysis is the most comprehensive way to diagnose male fertility issues. A semen sample is typically collected on-site and given to technicians who perform a variety of laboratory tests on it. The total volume of the sample is noted, and its pH is measured. Viscosity changes are observed over an hour as the sample rests. Semen normally liquefies over time due to enzymatic action, and failure to do so may detrimentally impact fertility as high viscosity can impair the ability of sperm cells to swim to their intended destination.

After the resting period, a technician mixes the sample with a solution to dilute it. A few drops of the dilute sample are placed on a special ruled microscope slide called a hemocytometer which allows them to visually count the number of sperm present in a fixed volume (concentration). In addition to count, the technician may also grade the quality of movement of each sperm cell (motility), the shape of the sperm (morphology) and whether they stick together (agglutination). The sperm concentration is multiplied by the original semen volume to get a total sperm count. The technician will also look to see if other types of cells are present, such as white blood cells, which can indicate infection. All of the data gathered at the laboratory is given to the physician for consideration. See our page on Understanding Results.

Strengths: The semen analysis is a very thorough test that explores all the characteristics of semen that are important for fertility.

Limitations: Some laboratories use a computer-aided system (CASA) to perform an analysis of images captured on the microscope. Doctors have said that these systems can sometimes make mistakes and if the doctor suspects an error they will request a manual count performed by a technician. While the technicians are incredibly well-trained and good at what they do, there is a bit of subjectivity that comes into play when manually counting cells and determining their morphology and motility. Because it is subjective and difficult to do, many clinics do not look at morphology. Additionally, studies show that semen analysis performed on the same sample by two different operators can vary by as much as 30%. So it should be considered more of an estimate, rather than an exact measurement. It is also widely documented that sperm counts vary from day to day and week to week. For this reason, the WHO recommends that at least two separate tests are performed days or preferably weeks apart to truly assess semen quality.

Also it is important to keep in mind that semen analysis is not a true test of fertility. Sperm counts, motility, morphology and the like are correlated with success rates but men with high numbers have had fertility troubles and men with low numbers have been able to conceive naturally with little problem. Semen analysis results do however help identify medical conditions related to the male reproductive track and are a good barometer of overall health in men. If you are struggling with unexplained fertility and semen analysis comes back good, it might be useful to request sperm function tests which can identify if sperm have trouble fertilizing an egg. Because sperm are involved with early cell division and development of embryos sperm function tests can also rule out causes of unexplained miscarriages.

Home Male Fertility Test Kits

Trak

Trak is a new system that is currently under development and will be available at the beginning of 2016.

How it works: The Trak system is build on principles of centrifical microfluidics – which means it spins. Semen is collected and placed in a liquefaction cup, which has enzymes that speed up the natural liquefaction process. A dropper of the liquefied sample is placed in the disposable test prop which is loaded onto the Trak engine. Once the lid is closed the engine will spin the sample down. The sperm cells will form a pellet in the channel at the bottom of the test prop. The height of the pellet corresponds with sperm concentration (sperm count). They are also developing a motility test. The motility test is planned to be released following the sperm concentration test.

EPT Male Fertility Test

Cost: $40

How it works: The EPT male fertility test uses colored dyes to stain sperm cells. The user collects a sample and places a drop on the test cassette. Then places two drops of a blue solution and two drops of a clear solution and waits for 5 minutes. If the sperm concentration is 20 million or more then the test well will turn dark blue to match the control.

Strengths: It is a relatively inexpensive test that can serve as a starting point to know where you stand. It also comes paired with an FSH test for women which can be an indicator of ovarian aging.

Weaknesses: While both tests can help identify problems in both the male and female partner, they don’t rule out other causes of infertility. On the male side, the cut off of 20 million

Micra

Cost: $80

How it works: The Micra is a home microscope kit that allows you to be your own lab tech. Semen is diluted using a liquid solution that comes with the kit. A dropper full of diluted sample is placed on a slide and sperm cells are counted on a grid that is visible by looking through the eyepiece.

Strengths: What’s really nice about the Micra is that is mimics the actual clinical test. The user can get some measure of both count and motility. The magnification isn’t high enough to clearly see morphology. This test has reusable supplies, so you can perform multiple tests and see how things change over time. Semen quality varies greatly from day to day so it is useful to do more than one test to get a good idea of general trends in sperm count.

Limitations: The fact that the test mimics the clinical test is also a disadvantage. Laboratory technicians are highly trained for analyzing cells under a microscope, and it may be difficult for someone to do this analysis at home with a plastic microscope. Sperm cells are particularly challenging to count as they can move not only from left to right on a microscope slide, but also up and down—causing them to drift in and out of focus. Because the equipment is lower quality than what the technicians in the lab use, it is difficult to focus the microscope correctly, and challenging to use it to get an accurate count.

SpermCheck

Cost: $40

How it works: This test works similarly to a pregnancy test. Semen is collected and placed in a liquefaction cup, which has enzymes that speed up the natural liquefaction process. A dropper full of liquefied sample is then mixed with a chemical that opens the sperm cells and releases their internal proteins into solution. A drop of this solution is then placed on a test strip. One blue line appears on the strip if you have fewer than 20 million sperm cells per milliliter, and two blue lines appear if you have more than 20 million sperm cells per milliliter.

Strengths: The major advantage of the SpermCheck is that it offers a quick and inexpensive at-home way to see if you have more than 20 million sperm cells per milliliter.

Limitations: The information provided by the SpermCheck is limited; it does not give a specific sperm count, but rather only if the count is above or below 20 million cells per milliliter Studies have shown that there is a direct correlation between sperm count and fertility. The more sperm you have, up to about 50 million cells per milliliter, the greater the chance of pregnancy. The SpermCheck also does not provide information about cell motility or morphology which are significant factors in determining male fertility.


Sara SDx

Sara SDx

Editor of Don't Cook your Balls, Co-Founder of TrakFertility.com, Health Coach and Men's Health Advocate. Passionate about sperm, men's health and helping people build their families.
Sara SDx

Author: Sara SDx

Editor of Don't Cook your Balls, Co-Founder of TrakFertility.com, Health Coach and Men's Health Advocate. Passionate about sperm, men's health and helping people build their families.

24 thoughts on “Getting Tested: Options for Testing Sperm”

  1. Hey Sara,

    I’m a male that is 31 years old and have a very healthy diet, a lot of good healthy fats, nuts/seeds, olive oil, spinach daily, avocado, tons of organic vegetables. I used to be on a drug called Finasteride which I was taking for male pattern baldness. I have been off it for about 98 days now, and I had another semen analysis at 70 days off the drug and the count only improved about half a million per ml.

    First Test: (while taking Finasteride)
    PH: 8.5
    Volume: 4.5
    Agglutination: None
    Motility 4hr (they wait four hours to test for some reason) 17%
    Progression 0
    Morphology: 74%
    Count 4.8 million per Milliliter (LOW)
    Total concentration: 21.6 million per ejaculate

    Test 2: (Off Finasteride for 70 days)
    PH: 8.0
    Volume: 5
    Agglutination: None
    Motility 1 H: 60%
    Sperm Progression: 3
    Morphology: 60%
    Count per Milliliter: 5.40 (LOW)
    Total concentration: 27 million

    So it went up a little bit and every other category like Motility, Morphology, and Progression are normal. Since I have now been off the drug for almost 100 Days, when should I test again. I have also added cold showers and icing my testicules 4-5 a day for 30-40minutes a day. Will this help? I think I may also have vericocele, which could be heating my testes up too much. You think I will see improvement…possible to get my partner pregnant with these numbers?

    Thanks!

    1. Have you tested T levels? It might be worth a consult with a urologist who specializes in male reproduction. A varicocele might be good to rule in or out (cooling could particularly help with varicocele) At least getting blood done on FSH and T levels (and maybe LH) to make sure they are in appropriate ranges.

      You are doing a lot of the right things. The changes are all headed in the right direction. Increase in volume, count, progression.
      If you go by total motile, natural conception is totally possible. Still not optimal, so additional improvement on numbers would help.

      Here’s some of what is known on testicular cooling. It looks like you have a good routine there.
      Diet looks fantastic.

      Regards to repeat testing. It depends on your resource. Some places lab tests are relatively affordable. I also worked to make a start up called Trak and often recommend that for repeat testing if you live in the US (it does count only but is a good way to make sure things are moving in the right direction). If affordable testing isn’t an option, then maybe 3 month intervals. If it is, then I usually recommend monthly during her period (so you don’t miss an opportunity to conceive if you are trying). I wouldn’t get too discouraged if it looks a bit up and down test to test. It can do that. But if multiple tests are trending in a direction, that is something to pay attention to.

      If you are currently trying and want to boost chances… you could look into the stork which is a home kit for artifical insemination. It’s a cool design as the collection part works like a condom then a section of it breaks off and can get placed on cervix to bring sperm closer to the goal. It’s a useful boost when your numbers are on the edge.

      Are you trying? If so, how long?

      1. Thank you so much for the reply Sara! We have been trying since last May, so about 1 year of trying now. In the beginning of trying we were basically just having unprotected sex, and we didn’t work on timing or anything. We have been more focused on the timing the past 4-5 months. I understand her cycle now more and it appears to be pretty consistent to time things properly.

        One thing I neglected to mention is I had a very bad accident 2.5 years ago and almost died. I was in a coma for 2 weeks and in physical rehab for 2 months. I had a TBI (traumatic Brain Injury), which is a long story – I fell about 30-40 feet, but have no ill effects from it at all – Praise God! I do have a titanium plate in my skull but you would never know it by looking at me. I know the pituitary gland and hypothalamus regulate a lot of hormones so those tests would probably be a good idea. I also possibly could have injured my testes on the fall, but I’m not entirely sure if they were harmed or not.

        A little background on my wife: She she was diagnosed with PCOS about 5-6 years ago, but now the doctors don’t think she has PCOS. She has regular periods now every month, but her cycle is usually 34 days an occasional longer. She usually ovulated on day 20-23 of her cycle from that last two times we tested with a OPK. She had a test done by her doctor as well and her fallopian tubes are clear and there are no blockages. So she appears to be okay for the most part, she does have occasional pain with her periods (after ovulation). She lost her period when she was abroad during college for about 5-6 years, but she has consistent ones now.

        We do have the stork and plan to use it the next cycle and see if we have any luck with it. Sorry, that was a lot of information.

        1. Scary. I’m glad everything turned out ok. Ya, hormone issues can orginate in the testes or the pituitary. Also, the medication may still be working it’s way out of the system and it messes with testosterone. So it’s useful to just get a snapshot of where you are. Let me know if you need a referral to a urologist near you. I know many of the good ones personally. 🙂

          Your wife sounds very similar to me. I also had PCOS which I resolved by losing a lot of weight and becoming a runner (among other things) by the time I was in a place to try to conceive my cycles were mostly regular but long. It still took me close to a year to get pregnant. So you guys might have a little bit of a combo issue going on.

          Because her cycles are a little off, I would definitely recommend trying to get regular intercourse in throughout the cycle. Maybe 3 times a week or so.

          Good news is that you are both in range to make it happen, and there’s a good explanation for why it’s taking a little longer. Doesn’t make it any less frustrating but maybe gives a little peace of mind.

          1. I will look into getting my T, FSH and possibly LH levels checked here soon or after her next cycle. She and I have also have been taking Fertileaid supplements and I have also been taking CountBoost by Fair Haven Health as well. She is about 2 weeks in, and I will be done with mine tomorrow. So, hoping that gives us a bit of a boost too. This last cycle was actually only 31 days, but her luteal phase was only 8 days and it’s supposed to be 10 to allow for implementation. Maybe since she is taking Maca and fertile aid supplements it’s trying to regulate her cycle since her cycle used to be around 34+ days. Not sure, but she also has a date for a surgery to see if she has endometriosis. She thinks it might be affecting her fertility since she usually has pain after ovulating. So, we both kinda have a lot going on, or trying to troubleshoot our issues, and it’s been tiring to be honest (which isn’t good either for fertility). We usually stick to the 2-3 times per week, which isn’t a problem since we both seem to not have libido issues. (Yay for positive things!).

            Thanks for the encouraging words. I will share with you my location via email instead of here if that’ okay so you can refer me to a urologist. I will let you know my location via email. Guessing you have it based upon I have to enter it to leave a comment.

            Thanks for the information and all the help – we are both grateful! 🙂

          2. Great. I’ll email you.

            Would you mind if I copied this thread into the community section of the site?

          3. I don’t mind if you copy the thread into the community section. 🙂 I created a topic already, but not sure if you can just delete that and copy this whole thread over.

  2. Hi doctor , I am manu ,age 27. I have undergone semen analysis and culture test . Following are the results .
    Colour – opaque Gray colour
    Volume – 2ml
    Liquefaction – after 30 min
    Reaction – Alkaline
    Count – 68 millions/ml
    Active – 60 %
    Sluggish – 20%
    Non- motile – 20%
    PUS cells – 2 -4 / HPF
    RBC – NIL / HPF
    Pls tell me is it enof to make a women pregnant ?

  3. Hi Sarah , I’m 27yer. Pleas translate analysis for me. been try two years but my wife is not getting pregnant.
    Appearance- whitish mucoid fluid
    Liquifaction -Normal
    Liquifaction time- 30 min
    (PH)-7.7
    Mortility 2hr – 38%
    Mortility. 4hrs-20%
    NP -12%
    MSC-25.7 million

    What can be the problem she is not getting pregnant Docter?
    Can you suggest what is the cause of infertility?

    1. Was there a volume listed on the report?

      I would guess that there are multiple factors impacting your fertility. Your numbers are a little lower than I like to see, but not so low that they should cause infertility. Just make it take longer to conceive.

      How are her cycles? Are they regular?
      How is your intimacy? Are you together on a regualar basis?
      Have you been trying every month for the full 2 years? Has she been evaluated?

  4. Pingback: app_main – Trak
  5. Hi Dr. Sara, Thanks a lot for your very good website. Given below is my Fertility test report,

    Volume: 1.5 ml, Reaction: Alkaline, Viscosity: Viscos, Liquification time : 45 min,
    Pus Cells 2-4/ HPF, RBC , Nil, epithelial cells Nil/HPF, Spermatogenice Cells 4-6/HPF
    Motility Progressive 75 %, Non Progressive 20%, Non motile 5 %
    Morphology Normal 40% Abnormal 60%
    Total Sperm Count 110 mill/cc
    Is it a normal Report?
    We have one daughter after nine months of marriage. But after that even passing 4 years we are not able to conceive. We faced breakups for 6 months to 8 months after initial 2 years due to my distance job. Can you suggest what is the cause of infertility?

    1. The sperm look healthy. I wouldn’t suspect that you would have too many problems.

      How is your wife’s health and her monthly cycles? are they regular? Are you able to have regular sex when you are home from your job?

      It seems that the main reason that you are not conceiving is likely because you are not spending enough time together. Sometimes it takes time to get pregnant and you are apart many months at at time. I have seen a number of men in your situation that take a long time to conceive.

      1. Thanks a lot for your reply.
        Her monthly cycles are regular. Yes when we are together, we have regular sex. How long it is necessary to stay together, If i adjust to take her at my job location.

        1. I would try to stay together for 6 months. During that time, you should try to have sex about 3 times a week and should try to monitor her cycle so that you are having sex during the most fertile days (there are really good apps to help track her cycle. there are also ovulation tests that will tell you exactly when she is most fertile). I would predict that you should be able to conceive within 6 months. If you do not, I would recommend further testing with a doctor.

  6. Comment…she said forms we’re double headed spermatozoa.she has regular cycle. She is 22 nd lm 28. During her ovulation dates lm always wid her.but the Docter said we both healthy to conceive bt it doesn’t happen

    1. For you, it is kind of a mystery. Your semen analysis looks pretty healthy to me. 2 years is a while to be trying. Some people have something called “unexplained infertility” which means that doctors can’t figure out why they are not able to conceive. About 20% of couples that have infertility have no good explanation for what could be causing it.

      Have you had any breaks from each other during the two years?
      How often are you typically able to have sex in a given week or month?
      Do you have other things that make you feel concerned about it?

  7. Hi Sarah , I’m 30 yer. Pleas translate analysis for me. been tryn two years but my wife is not getting pregnat.
    Count – 134.3 million/ml
    Appearance- Opaque
    Liquifaction time- 30 min
    Reaction (PH)-7.0
    Mortility 1hr – 90%
    Mortility. 3hrs-75%
    Mortility 6hrs-60%
    Morphology..abnormal forms; Double-headed Spermatozoa.

    What can be the problem she is not getting pregnant Docter?

    1. Did it give any percentage of abnormal forms?

      These numbers look pretty healthy and seems like you should be able to conceive.

      Has she been checked by her doctor?
      Does she have a regular cycle that lasts between 28-30 days?
      Does she experience any pain during her period?
      Does she have a lot of stress?
      How old is your wife?
      Are you able to be intimate on a regular basis (at least 2 times a week?)
      Have you had any gaps in time trying to conceive or have you tried every month?
      Do you monitor her cycle to know when the fertile times are?

  8. Hii Sara, I’m dinesh 24 my sperm quintity: 2.0 ml and color : milky white. liquefication time :20-30 minutes . ph reaction: positive. total count :24 and reference range : more than 20 million/ml . And pus cells :1-2/hpf. Precurser cells :2-3/hpf. And Morphology normal forms :65%. Abnormal forms:35%. And head 10. Body 10 .Tail:15 . And motility :lll & lv: 05 rapid linear progress % .and ll: 15 sluggish linear progress %. And l : 45 no progressive %. And I O : 35 non motile % this is my spenm report mam plz suggest it is good or bad report.

Comments are closed.