The rise of at-home semen tests
There’s a growing number of at-home semen tests for people who are concerned about their fertility (perhaps because their attempts at conceiving a child are unsuccessful, they wonder whether their vasectomy was a success or, perhaps, are just curious).
Six at-home semen tests are approved by the Australian Therapeutic Goods Administration and are listed on the Australian Therapeutic Goods Register2, but even that is no guarantee they are useful. None of the at-home semen tests provide the same information as even the most basic tests run in a fertility lab.
At-home semen tests use a few different types of technology; some work in much the same way as COVID-19 RATs, while others use devices supplied with the test kits3. There are a few that connect to a phone, allowing the user to either count sperm themselves, or for counting to be done by image analysis software in an app.
None of these tests are as accurate in making these measurements as laboratory tests.
In Australia, fertility services are regulated by the government, and "the following parameters must be measured when the semen analysis is performed
for assessment of fertility:
(a) semen volume
(b) sperm number and/or concentration
(c) sperm motility
(d) sperm morphology
(e) presence of cells other than spermatozoa
(f) presence of agglutination and its nature.”4
The simplest at-home tests measure whether or not a semen sample contains any sperm; others show whether sperm concentrations (the number of sperm per ml of semen) are lower than normal or supposedly high enough to allow a pregnancy; some provide measurements of sperm motility (how well the sperm ‘swim’) along with estimated sperm concentrations.
However, even the most ‘advanced’ at-home tests provide only a fraction of the information needed for a doctor to properly assess fertility.
Are at-home semen tests accurate?
At-home semen tests put users at risk of receiving misleading results. This means a user who is fertile might think they are not, or someone who is infertile might be led to believe they are fertile. With laboratory tests, there are checks and balances to prevent false-negative and false-positive results and follow-up tests that help to confirm or explain test results.
The downsides of doing a semen test at home
With at-home semen tests, there’s no follow-up testing. But more critically, there’s no one to help interpret test results, help you understand them, or to perform other tests to provide a complete assessment of fertility.
For any semen test, there is no cut-off value for fertility, unless there are absolutely no sperm or they’re not moving at all (at-home tests aren’t sensitive enough to measure this). There are many things to consider when it comes to fertility; a semen test is only one part. Some people with semen test results that suggest they may be infertile actually have no problems conceiving a pregnancy, while others with normal semen test results have sperm that just can’t fertilise an egg (no semen test can tell you this).
‘It takes two, baby’5
Fertility is something that is experienced by couples, not individuals. It takes (at least) two people to make a baby.
It is recommended that when a couple seeks care for infertility, investigations should be done for both partners. This is because they each may have problems that, alone, might not threaten fertility (they might be ‘sub-fertile’ instead of infertile), but together the problems combine to prevent them from having a baby. By providing information about only one partner, it is impossible to know about interactions with the other partner’s fertility status.
Doing a semen test at home might seem convenient, private and inexpensive. But it can’t provide a complete fertility assessment, might cause unnecessary alarm or a false sense of security, and could delay seeing a specialist who can provide the help that’s needed to overcome problems with making a baby.
There are some things in life that are best left to the experts. The best home baker, who makes all the family’s birthday cakes, would probably leave their own wedding cake to a professional. Replacing a couple of boards on the back deck is probably easily done by your average home handyman, but they’re not going to build their own house. When it comes to making babies, personal involvement should only go so far. The outcome is too important for do-it-yourself approaches. Any concerns about fertility should be dealt with by experts.
Pros and cons of at-home testing
Home pregnancy tests have been around for years, but the use of at-home medical tests by men was fairly uncommon until recently when Rapid Antigen Tests for diagnosis of COVID-19 became familiar to us all.
At-home tests are gradually becoming available for health conditions that used to require measurements in specialised laboratories. Some home tests are very accurate, like blood glucose tests and blood pressure monitors. Others are somewhat limited, like at-home tests for cholesterol that can measure the total amount of cholesterol in a blood sample from a pinprick, but not the levels of specific cholesterol types.
The best at-home health tests aren’t as good as the tests performed in specialised laboratories. That’s why positive home pregnancy test results, which are usually quite accurate, are followed up by a laboratory urine or blood test ordered by a health professional. A doctor would never base their diagnosis or treatment on the results of a test you do at home.
Even though at-home health tests aren’t as good as the ones your doctor orders, they can be useful because they:
- Give people some control and an opportunity to take responsibility for their health
- Can increase testing rates for health problems, which can result in early diagnosis and treatment
- Are convenient (you don’t need to visit a doctor; you can do the test when you want; you don’t have to wait for results)
- Are anonymous (if you’re embarrassed about wanting the test or doing it, nobody knows).
At-home health tests have disadvantages though1:
- They can cost a lot of money, and may have a greater ‘out-of-pocket’ cost than tests ordered by a doctor, which have Medicare rebates
- They tend not to be used by the people most at risk of disease
- They don’t provide all the information needed to make a diagnosis
- They are more likely than laboratory tests to give false positive and false negative results, leading to unnecessary worry or a false sense of security
- There may not be anyone to help you deal with the consequences of an unwanted test result.
Overall, we don’t really know if at-home health testing is good or bad1.
- Grispen et al., 2011. To test or not to test: A cross-sectional survey of the psychosocial determinants of self-testing for cholesterol, glucose, and HIV. BMC Public Health
- Gonzalez et al., 2021. Clinical Update on Home Testing for Male Fertility. The World Journal of Men's Health
- National Pathology Accreditation Advisory Council, 2017. Requirements for semen analysis. Australian Government Department of Health
- Stevenson & Moy, 1965. It Takes Two. Motown