No man likes doing semen analysis testing. For most men, it is an awkward experience at best- turning a very private experience into a much more public event than any man really would ever want. However, the semen analysis test is an extremely underused tool in the management of infertility problems. Did you know that fully 50% of couples who are having trouble conceiving have a male factor issue contributing to their difficulties in either conceiving or maintaining a healthy pregnancy? So when couples start their fertility evaluation process, why does only a relatively small proportion of men get semen analysis testing as one of the initial steps?
There are a few reasons:
#1) There is much more awareness in the community regarding female fertility issues as opposed to male infertility. On-line forums and chat rooms abound on the topic of female fertility problems. However, it is rare to find discussion groups of men willing to open up about their experiences with low sperm counts or ejaculatory problems. The medical device and pharmaceutical industries also have a much larger stake in female infertility, as female fertility treatments (such as IVF) yield them much greater opportunities for profits. Advertisements and public awareness campaigns financed by these companies also help to keep awareness of female fertility issues much higher.
#2) Medical training. Doctors are more likely to receive a basic education in female infertility issues than male problems. Most every Ob/Gyn doctor has some solid basic training in female infertility problems and can adequately handle a routine evaluation as well as some “low-tech” treatments, such as Clomid or laparoscopic removal of endometriosis. In contrast, the baseline knowledge of general urologists of the basics of male infertility management is relatively low. A recent survey found that 25% of general urologists would consider using testosterone to treat male infertility- fully 1/4th of the urologists surveyed were apparently unaware of the fundamental fact that giving a man testosterone actually decreases sperm production. As for the availability of fellowship-trained experts, there are currently 41 programs in the United States training female fertility experts (reproductive endocrinologists) each year, as opposed to the 13 male infertility fellowship programs training male infertility experts. This number of male fellowship programs represents an improvement compared to 10 years ago when there were only 6 programs, but there is still a wide difference in the number of female vs. male fertility fellowship programs despite the fact that half of all infertility couples have male fertility problems.
#3) Otherwise healthy men are often not enthusiastic to become patients. As a man myself, I can say that many (but not all) young men are much more reluctant to see the doctor or seek medical attention than are women. Women generally have been seeing an Ob/Gyn for yearly exams since their teens. Even though getting a semen analysis test is non-invasive and relatively easy to perform, it is often avoided or deferred initially, which can slow down the path to optimal fertility care. I see couples not infrequently who have been undergoing female evaluations and treatments for a year or longer before someone thinks to have the man tested. Then they find out that his sperm count is extremely low and realize that they have needlessly wasted both time and money pursuing the wrong course of management.
The bottom line: every man in an infertile couple should have semen analysis testing at the start of the couple’s fertility evaluation.
It is relatively inexpensive (and sometimes covered by insurance), has no risks or side effects, and potentially provides extremely valuable information. An abnormal semen analysis can also be the first sign of potentially serious medical problems (such as testicular cancer, pituitary tumors, or hormone problems).
If you are interested in maximizing your chances of achieving a pregnancy and delivering a healthy child, do not delay starting the male fertility evaluation. Ladies: it takes two to tango, so don’t leave your partner on the sidelines as you start down the path of an infertility evaluation.
For more information on the importance of semen analysis testing, check out this link: