Do you want a sperm count with that Valentine’s Day card?

Next Valentine’s Day, as your dearly beloved runs into the local drugstore for that last-minute Valentine’s Day card and box of chocolates, he will also have the chance to pick up an at home sperm count test called SpermCheck. I used to joke that we take all the “fun” out of conception in the IVF lab. More true than funny, explaining why I don’t make a living as a comic. Soon, you’ll be able to do a non-fun semen analysis at home too. (Actually, if you really want this test, you can already buy it on-line.)

Recently, Walgreen announced that starting in April 2012, they will start to sell SpermCheck  in 7,800 Walgreen stores. How does SpermCheck work?  It is an antigen based test, like a pregnancy test,  where you look for a binding between an antigen and its antibody on a pretreated strip. The reaction between the antigen on the sperm and the pretreated strip causes a color change. For SpermCheck, the man mixes a pre-determined volume of his semen with liquid supplied in the test kit. The mixing releases a sperm protein from the sperm called SP-10. If he has at least 20 million sperm per milliliter, there is enough reaction between the free SP-10 and the test strip to form a reddish line on the test strip. (I have to wonder how bright this reddish color is because they have a disclaimer that “Poor vision and/or improper lighting may affect interpretation of the results.” So,  don’t perform this test by candle light.)  Twenty million sperm per milliliter is the cutoff for minimal normal sperm concentration. Detailed instructions for using the kit can be found here.

I have mixed feelings about this at-home sperm count test. On one hand,  any man who takes the initiative in getting his part of the reproduction effort tested is really stepping up as a partner in the procreative effort and that is a very good thing. I am saddened when I see couples in the clinic where the woman is being prodded, examined, injected and annoyed on a daily basis for diagnosis and then treatment; meanwhile,  her man balks at ejaculating in a cup. I have to wonder,  if he can’t man up for the simplest part of the effort, will he help with the heavy lifting of taking care of a newborn and then all the not so fun stages of childhood? Where’s the commitment?

So kudos for initiative, but I still have some concerns about these at home tests. They can not replace a full semen analysis in a laboratory.

If the result is good and your man’s test result shows that he has at least 20 million sperm per ml, that doesn’t rule out male infertility. Why? Because the test looks for an antigen on the sperm surface that doesn’t distinguish between live or dead sperm, swimming or non-motile sperm, just reports how many sperm cells are present. So it is possible to have 20 million dead, non-moving or very sluggishly moving sperm.

Another limitation of the test is that unlike a regular semen analysis in the lab, you don’t get any feedback about what the sperm look like. If the sperm have a high percentage of abnormal forms, you wouldn’t know it from this test.

Sperm tests, performed at home or in the lab, can give misleading results if the sample is not fully liquefied before testing. Sperm is initially gluey and thick. With time, usually within 30 minutes,  it thins and it is possible to thoroughly  mix the sample so that sperm are present in the same concentration in every part of the sample so you don’t have a sampling error. Sometimes, sperm is so thick, it does not liquefy on its own even after an hour or more. In the lab setting, we can add a proteolytic enzyme (chymotrypsin) to liquefy the specimen and perform an accurate test. You can’t do this at home.

This limited at home test is not cheap- $40. If your insurance pays for semen analysis at a fertility lab, you’ll get a more thorough test for free. A regular semen analysis will usually also report on other aspects of the semen sample, such as percent of motile sperm, how well the sperm swims (percent progressive forms), presence of agglutinated sperm (suggesting antibodies), presence of RBCs (suggesting blood in the sperm tract), presence of white blood cells (suggesting infection, if high)  and the pH of the sample (which has urological implications if pH is too acidic or too basic). The assessment of percent normal forms (the morphology test) is typically performed as a separate test from the routine semen analysis but not always. If you have to pay for the semen analysis out of pocket, it will typically cost somewhere between $80-150 at the clinic. Be sure to ask what any tests cost in advance and also check with your insurance company to see if the test is covered.

Patients seem to be reluctant to ask what health care will cost and whether insurance will pay for it. Your clinic should be able to answer these questions for you. All clinics have someone responsible for the finances of the clinic and this person routinely checks insurance coverage on patients so that the clinic can charge the self-pay portion and bill the rest to insurance, if applicable. Don’t be afraid to ask.

Because  the at home test is inconclusive- even for positive results- you’ll end up needing a regular semen analysis anyway so it might just make more sense to just do the test in the clinic and save the $40 for a nice dinner out. Happy Valentine’s Day.

 

 

 

 

© 2012, Fertility Lab Insider. All rights reserved.

©2012 Fertility Lab Insider. All Rights Reserved.

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