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. A semen analysis entails producing a semen sample via self-stimulation in a private environment. It usually takes place in a room in at a fertility clinic or urologist office, but it can possibly be done at home if you live close enough to the testing center.

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? The answer is yes, it is necessary. If a couple is having difficulty getting pregnant, both partners should be evaluated.

But what if the gynecologist already found fertility problems in the female partner? Even then, the male partner needs to be tested. 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. This can be an emotionally sensitive subject.

Some 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.

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.

The age-factor is even more important to consider if the male partner is five or more years older than the female. Research has found that this can significantly increase the risk of a couple facing infertility.

Don't waste time and get tested.

Early Sperm Analysis Saves Money

Not completing male fertility testing up front can be a very expensive mistake. 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. If you do end up needing IVF, you don't want to have already lost money on treatments that couldn't work (because of undiagnosed male infertility.)

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.

Coping with Semen Analysis Testing Anxiety

Being told to go into a room and orgasm—on demand... for science—is not easy. Here are some things to consider to possibly reduce your anxiety or make the process a little easier.

Talk to your partner if you're concerned about judgement. 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.

Ask your doctor if you can do the test at home. The semen sample must be tested soon after it's produced. This is one reason why you're usually asked to complete the test at the fertility clinic or testing center. However, this can be really difficult for some men. There are options if you struggle to produce a semen sample, whether for testing or treatment purposes. One possible option is to do it at home. Ask your doctor if that's a possibility.

Talk to your religious clergy person. Some religions have strict rules regarding masturbation, but will be lenient when it's done for a medical need. Talk to a trusted member of the clergy for clarification. That said, some couples consider going against their religious customs for the sake of having a child. This is a personal and sometimes difficult choice to make, but not an uncommon one.

Discuss your anxiety with your doctor. It's okay to tell your doctor that you're nervous about the test. While you may feel embarrassed to talk about the subject, this is your doctor's profession. You're not the first man to tell them that masturbating at the fertility clinic is "difficult" ... to say the least!

A Word From Verywell

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.

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Article 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.