A ‘guy-necologist’? Startups push semen analysis as male Pap smears

Sperm, once believed to contain a full, minuscule human ready to be implanted and grow in the womb, has come a long way in terms of understanding and significance. Dutch naturalist Nicolas Hartsoeker’s 1694 drawing in his review of magnifying lens technology, “Essai de Dioptrique,” depicted sperm as a drop-like form with a lower part of a human body crouched inside, holding its knees below a large sphere with an open perforation at the top. This image, though inaccurate in its portrayal, laid the foundation for future studies of human reproduction.

It took over a century for sperm to be named spermatozoa, derived from the Ancient Greek for “seeds of living beings,” and even longer for its physiology to be comprehended. Today, research in fertility and urology suggests that sperm can serve as a proxy for the overall health of the individual who produces it, offering insights beyond just fertility.

Spermatogenesis, the process of sperm production, is a marvel of abundance, with approximately 1,500 units generated per second, totaling up to 300 million per day. Men can produce up to a trillion sperm cells in their lifetime, with each ejaculation containing millions of sperm that are created over a period of two to three months. However, for the 11.4% of men in the U.S. who struggle with infertility, the numbers are significantly lower, and the implications extend beyond reproductive health.

Studies have shown correlations between infertility, particularly low motile sperm count, and various health conditions such as metabolic disorders, cardiovascular disease, and certain types of cancer like testicular and prostate cancer. A study conducted by Copenhagen University found that men with low motile sperm counts had a life expectancy nearly three years shorter than those with normal sperm counts, and issues with sperm quality were linked to increased all-cause mortality.

In light of these findings, experts like Paul Turek advocate for men to undergo routine semen analyses not just for fertility purposes but also for the prevention of diseases. Turek suggests that semen analysis could serve as a biomarker for broader male health and proposes the idea of “guy-necologists” who can monitor and address male reproductive health issues. Companies are emerging in the testing and fertility sectors, offering services like mail-in semen analysis and at-home sperm testing to cater to the growing interest in male fertility.

While the idea of using semen analysis as a preventive measure for male health conditions is gaining traction, some experts remain skeptical, citing the need for scientific consensus before widespread adoption. Semen analysis provides insights into fertility and overall health by assessing parameters like semen volume, sperm concentration, motility, and morphology. By analyzing these factors collectively, healthcare providers can identify potential issues such as alcohol or drug consumption, obstruction, or genetic factors that may impact fertility. Ultimately, semen analysis has the potential to serve as an early warning system, alerting individuals to potential health risks and prompting further investigation and intervention. While it is true that men rarely undergo semen analysis tests, experts believe that there could be significant benefits to incorporating these tests into routine health check-ups for men. James Smith, a professor of urology at the University of California San Francisco, and chief medical officer of semen analysis company Fellow, noted that current practices typically only involve semen analysis when a couple has been trying to conceive for an extended period. This often leads to immediate interventions like IVF, rather than addressing potential underlying causes of low sperm count.

Smith emphasized that it takes three months to produce new sperm, so by the time a semen analysis is conducted, the pressure to conceive quickly may override the opportunity to investigate and treat the root causes of infertility. This rush to IVF also discourages men from participating in research trials focused on male fertility, as they fear being assigned to a control group with no active treatment.

However, proponents of incorporating semen analysis into routine health check-ups argue that it could provide men with valuable insights into their reproductive health before they are actively trying to conceive. This proactive approach could not only identify potential fertility issues but also uncover underlying health conditions or genetic risks that may affect future health.

Michael Eisenberg, a professor of urology at Stanford, believes that knowledge of one’s fertility status could serve as a motivator for men to engage more proactively with their health care. By normalizing regular visits to a healthcare provider for fertility assessments, men could become more comfortable seeking medical help for other health concerns as well.

Paul Turek, a male fertility specialist and advisor to the Men’s Health Network, sees the integration of semen analysis into routine health checks as an opportunity for preventative medicine in young men. By identifying and addressing issues like low sperm count, weight management, diabetes risk, and cancer predispositions early on, men could potentially improve their overall health outcomes.

However, some experts, like Barry Kramer, a professor of medicine at Dartmouth, caution against overutilizing semen analysis tests without specific symptoms or indications. He stresses the importance of evaluating the reliability and accuracy of any diagnostic test before implementing it on a broad scale. Without clear evidence that routine semen analysis outside of fertility concerns leads to improved health outcomes, Kramer advocates for a more targeted approach to testing.

In conclusion, while the idea of incorporating semen analysis into routine health check-ups for men holds promise in identifying and addressing fertility and health issues early on, further research and evaluation of its efficacy and benefits are necessary before widespread adoption. Balancing the potential advantages of proactive fertility testing with the need for evidence-based medical practices will be crucial in determining the role of semen analysis in men’s healthcare moving forward.

More importantly, he said, there has to be evidence that it improves outcomes, such as quality of life, overall health, and life expectancy, something that is yet to be proven for semen analysis, given that it hasn’t been performed on a sizable scale so far.

Woloshin brings up an ethical issue, too, raising the threshold these kinds of tests need to clear in order to be considered beneficial: This wouldn’t be something that is done in response to a patient complaint, but upon physician prompting. “The doctor is saying, ‘you may think you’re healthy and you may not recognize the problem, but let me tell you something that I think you should get’,” he said. This can cause distress, misplaced concern, and overdiagnosis: all harms that have to be weighted against the potential benefits provided by the test.

Turek isn’t too concerned about causing undue health concern. In fact, he sees it as potentially helpful. “Patients unfortunately get a little worried, and that’s important because we’d like them to worry because men aren’t immortal,” he said.

But the cascade of tests that may follow a semen analysis that showed low sperm count or other issues has to be considered from an economic point of view, too, said Emmanuel Drabo, a health economist at the Johns Hopkins Bloomberg School of Public Health. “Literature generally tells us that semen analysis could be leveraged in primary care as some sort of a gateway for men’s health, using fertility concerns as some sort of an entry point,” he acknowledged.

Though as promising as semen analysis may be as a biomarker, he said, it may not be the best screening tool. “Are we going to have unnecessary imaging, unnecessary hormonal tests, unnecessary referrals that are due to mildly abnormal semen results?” he said, noting that this would have an impact in terms of health equity, too. “Resources that we divert toward semen testing are resources that we could have used in other areas of health,” he said.

Still, Drabo doesn’t altogether discount the value of introducing semen analysis in absence of specific symptoms. “Public health is not only about treatment of diseases, it’s about prevention,” he said. “There is potential value in anticipating and addressing problems up-front.”

The business of semen analysis

The public health experts STAT spoke with were especially skeptical about the idea that a semen analysis could draw men at scale into the doctor’s office.

It would be “a new test that costs money, takes time, requires the patient to do something it wouldn’t ordinarily do and bring in his sperm for analysis,” said Woloshin.

Indeed, even those who are excited about the potential of expanding the scope of semen analysis point to the logistical challenges the test presents. The gold standard is to test the semen within an hour of ejaculation to get an accurate evaluation. To do so, a patient has typically two options, neither of which is especially comfortable. One is “having the collection process in a strange room in a strange office, and a lot of guys understandably aren’t comfortable with collecting a specimen in that way,” said Charles Jenkins, the product director of Quest Diagnostics women’s and reproductive health. “The other way is to collect it at home and drive it in and then you’re kind of that NASCAR driver trying to make sure that you’re gonna get over the finish line in time,” he said.

Adding to the complexity is the fact that not all labs offer semen analysis, which requires dedicated instruments and expertise but is not reimbursed at a level that makes it worth the investment, so for many patients even finding a lab may require some effort. “There’s a ton of barriers, and that leads to men not doing [semen analyses] very often,” said Smith, who points out that for this reason only 30% of men who had a vasectomy follow it up with a semen analysis to check that it worked, despite it being the recommendation.

Hoping men would overcome such challenges just to get a peek into their fertility may be too optimistic. But even before benefits are unequivocally demonstrated, the interest in making semen analysis more easily accessible is being accompanied by business innovation and growth. Enter mail-in testing, one of the offerings trying to benefit from the growing male infertility market, estimated at $4 billion a year.

Fellow, Smith’s semen analysis company, developed technology that preserves sperm for up to 72 hours, allowing patients to collect samples at home and send them in a package specially developed to maintain their quality. The company, which launched its services in 2020, will test semen to assess fertility for $199, with an option to pay $140 to freeze sperm. Tests can be ordered directly by patients, who then may need to find specialists to interpret them, or by physicians. Legacy, a competitor, offers standard semen analysis for $295, which goes up to $540 for sperm freezing. Jenkins’ lab, which he founded in 2008 as ReproSource then sold to Quest, doesn’t provide direct-to-consumer options, and offers a broader range of fertility testing. Though it, too, processes mail-in samples (its technology keeps them viable for 26 hours).

These labs’ potential client base would grow exponentially, if Turek and other semen analysis enthusiasts — who all have at least some involvement with businesses offering convenient semen analysis solutions — are successful. He is determined to be, as he sees popularizing the test as his contribution to ending what he calls a neglect of male health. “The richest men in America live six years less long than the poorest woman,” he pointed out.

We have a huge life expectancy discrepancy in America, and this is my approach to eliminating it.

Life expectancy in America varies greatly depending on factors such as race, income, education, and location. This discrepancy is a major issue that needs to be addressed in order to ensure that all individuals have the opportunity to live long, healthy lives. In this article, I will discuss my approach to eliminating this life expectancy gap and promoting health equity for all Americans.

Understanding the Discrepancy

According to recent studies, there is a significant gap in life expectancy between different demographic groups in America. For example, individuals living in poverty have a much shorter life expectancy than those who are more affluent. Similarly, African Americans and other minority groups face higher rates of chronic illness and premature death compared to their white counterparts. This inequality in life expectancy is unacceptable and must be addressed through targeted interventions and policies.

My Approach to Eliminating the Discrepancy

As a public health advocate, I believe that addressing the root causes of health disparities is essential in eliminating the life expectancy gap in America. This approach involves implementing a range of strategies that focus on improving access to healthcare, promoting healthy behaviors, and addressing social determinants of health.

One key strategy is to increase access to affordable healthcare for all Americans. This includes expanding Medicaid coverage, improving healthcare quality in underserved communities, and reducing out-of-pocket costs for essential health services. By ensuring that everyone has access to high-quality healthcare, we can help prevent and manage chronic conditions that contribute to premature death.

Another important aspect of my approach is to promote healthy behaviors and lifestyles among all individuals. This includes implementing public health campaigns to raise awareness about the importance of regular exercise, healthy eating, and smoking cessation. By empowering individuals to make positive choices for their health, we can reduce the burden of chronic disease and improve overall life expectancy.

Additionally, addressing social determinants of health is crucial in eliminating the life expectancy gap. This involves tackling issues such as poverty, housing insecurity, food insecurity, and lack of education. By investing in programs that address these social determinants, we can create healthier and more equitable communities where everyone has the opportunity to thrive.

Conclusion

In conclusion, the life expectancy gap in America is a complex issue that requires a multifaceted approach to address. By focusing on improving access to healthcare, promoting healthy behaviors, and addressing social determinants of health, we can work towards eliminating this disparity and ensuring that all individuals have the opportunity to live long, healthy lives. It is essential that we continue to advocate for policies and initiatives that prioritize health equity and strive to create a more just and equitable society for all Americans.