Do You Really Need to Have a Semen Analysis?

Why Male Fertility Testing Is a Must for Every Infertile Couple

Female doctor sitting with male fertility patient, getting instructions for semen analysis
At-home sperm count tests are inaccurate and a waste of money. The best option is a semen analysis, which is available through a urologist or a reproductive endocrinologist. Cavan Images/Stone/Getty Images

Many men worry about having a semen analysis or sperm count test done. While fertility testing often starts with the female partner, the male partner may be surprised to learn he needs testing too.

Is it really necessary? Especially if the gynecologist already found fertility problems in the female partner? The answer is yes, it is necessary. A woman's diagnosed fertility problem doesn't give the male partner a clean bill of health.

In fact, up to one-third of infertile couples discover fertility problems in both partners.

Why Are Some Men Hesitant to Have a Semen Analysis?

When sperm count testing comes up, usually at the request of a savvy gynecologist or at a fertility clinic, some men may not want to go through the testing. 

Most men who don't want to be tested are fearful of being judged. They worry that they will be deemed less "masculine" if they discover they are infertile. Some men are afraid their partners will respect them less or leave them.

Another reason some men may refuse a semen analysis is out of religious objections. Some religions forbid the "spilling of seed," and in some cases, this includes producing a semen sample for testing or even fertility treatment.

Anxiety over needing to masturbate in a fertility clinic is another reason some men are hesitant to have a semen analysis. (In some cases, you may be able to produce the sample at home and bring it into the clinic.

Talk to your doctor about this option.)

What About At-Home Male Fertility Tests?

You might be tempted to try one of those at-home sperm count tests instead of doing a semen analysis. These tests are a waste of time and money. They are inaccurate and don't provide a full male fertility evaluation.

A complete semen analysis is an essential part of a fertility workup for any couple facing infertility.

It's understandable to be nervous. But it is best to have a semen analysis done before any treatments are started. Here's why.

Early Sperm Analysis Saves Time

The earlier the testing is done, the sooner you can know what you're dealing with.

If all the focus is on the woman's fertility only, and treatment begins focusing only on her problems, what happens if male infertility is also a factor? The treatments will be either doomed to fail or significantly less likely to succeed.

In the case of Clomid, for example, there are limits on how many consecutive treatment cycles are allowed.

If a woman takes Clomid for the maximum allowed cycles, doesn't get pregnant, and only afterward it is discovered that there are male factor infertility issues, the couple will have lost not only the treatment time but also may need to move onto other medications.

Another factor to consider is age. Especially after age 35, a woman's fertility declines at a faster pace.

Several months of inappropriate treatment may lead to a lower chance of success once the right treatment option is discovered.

Early Sperm Analysis Saves Money

Consider the cost involved in fertility treatments.

Insurance companies vary with regards to coverage, but a cycle or two of gonadotropins (aka injectables) can cost in the thousands of dollars.

If IUI, IVF, or IVF with ICSI are what were actually required, you will have thrown money away. (Though it would be very unusual for a doctor to go ahead with injectable fertility drugs without male fertility testing.)

However, even with Clomid, costs can add up if your insurance doesn't cover ultrasound or blood work for monitoring the cycle.

Not only will you have lost money on treatments that were not appropriate, you will have that much less money for further treatments.

With the average cost of IVF between $10,000 and $17,000, every dollar counts.

Sperm Analysis May Save You Some Heartbreak

Perhaps even more important than lost time and lost money, getting the semen analysis done early may save you some heartbreak.

Any couple coping with infertility knows how hard it is to go cycle to cycle. A negative pregnancy test during treatment is especially difficult.

Finding out months later that the treatments had little or no chance for success will add to the sadness its own ocean of anger and pain.

The Bottom Line: Get Tested Before Starting Any Treatments

Save time and heartbreak by getting at least basic fertility testing for both you and your partner right away.

When the woman goes to see her gynecologist, the man really should seek out a urologist for an infertility work-up. Or you may both see a reproductive endocrinologist.

If the semen analysis comes out normal, you'll have eliminated a potential cause. If there are problems, you can be sure to start appropriate treatment faster.

Just one last note to nervous husbands and boyfriends: If you're nervous of what your partner will think of you if the sperm is less than stellar, ask her. She'll likely tell you that she will care for you as much after poor results as she did before.

On the other hand, if she goes through fruitless treatments because you refused a simple test early on, that could harm your relationship.

Sources:

Patient's Fact Sheet: Diagnostic Testing for Male Factor Infertility. American Society of Reproductive Medicine.

A Basic Guide to Male Infertility: How to Find Out What's Wrong. American Urologic Association. http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/patient-guides/whatswrongpg.pdf

Medications for Inducing Ovulation: A Guide for Patients. American Society of Reproductive Medicine.

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