NEW YORK, United States — Making a baby only needs one sperm. But 30–50% of couples with fertility problems have a male factor issue. Semen analysis remains the cornerstone of the evaluation of male fertility, but it has limitations.

A review of current male fertility testing, published in Fertility and Sterility. looks at traditional semen analysis and newer tests.

Male fertility potential is extremely difficult to predict based on single, or repeated semen analysis. The authors conclude “semen analysis is not a blank check for fertility or infertility diagnosis — it must be used as a key guideline to direct management/therapies”.

Semen analysis is not a blank check for fertility or infertility diagnosis.

Sergio Oehninger, Sher Fertility Institute

Tests cannot evaluate the complex relationship between sperm and the female reproductive system or interaction with the egg. Currently, no good test exists to test sperm function.

New smartphone tests now exist allowing testing at home or in the developing world. Nonetheless, these tests have yet to shown to be as good as lab testing.

DNA Fragmentation

Sperm are fragile, and the DNA can be easily damaged. The two most common tests assessing the amount of sperm DNA fragmentation are:

  1. TUNEL technique
  2. Sperm Chromatin Structure Assay (SCSA)

Both tests are reliable but do not diagnose absolute damage to sperm. Furthermore, it is not possible to sort sperm to use only undamaged sperm for fertility treatment. Therefore, the ASRM says “there is insufficient evidence to support the use of these tests in clinical practice.”

The Bottom Line: Despite its limitations, semen analysis based on World Health Organisation Criteria is the only evidenced-based male fertility test.


Matt is an NHS Consultant in Newcastle with over ten years of experience. His PhD research into subfertility and miscarriage involved developing a clinical trial and patient engagement.