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Interviewer: At-home male fertility tests that you get over the counter. You go to the drugstore, you get the fertility test, you take it. Does that give you helpful information? Are they accurate? Are they worthwhile? That's what we're going to find out today from urologist Dr. John Smith. What is your take on those over-the-counter, at-home male fertility tests?

Dr. Smith: We see a lot of people for fertility at the University of Utah, and those at-home tests really are very rudimentary. They don't tell you a lot of information. They pretty much tell you if you have an adequate amount of sperm in the ejaculate or not. And that's really all they can tell you.

So if you had a positive test where it said, "Hey, you've got enough," that doesn't tell you if those sperm are alive, if there's any motion in those sperm, the morphology or the shape of those sperm. It doesn't give you really any other information. The only thing it tells you is if there's enough sperm there to hopefully not have fertility issues.

And the way these tests work is similar to a pregnancy test where it looks for a protein that's only on the sperm. And so that's how they quantify. So you've got to have enough of that protein in order to have the test come back positive that you've got a high enough quantity of sperm to have a normal sperm count.

Interviewer: But if partners have been trying to have kids and they have not been successful, and the man goes and gets this and finds out, "Oh, hey, I've got enough sperm according to this test because they detected enough protein," but you're still not having kids. You really haven't solved anything by taking the test, have you?

Dr. Smith: No. You really haven't. And that's the other part of things that go on. There's also two parties when you're trying to have kids. You've got the male side of fertility and the female side of fertility, and we're going to talk about the male side today.

But if you have been trying unsuccessfully, having unprotected intercourse for over . . . usually the definition is one year. Some people will say six months to a year. But all in all, if you've been trying and you haven't been successful and you get that at-home test and it tells you that there's enough sperm there, that still doesn't tell you that there's not necessarily a problem. Because if there's low motility, meaning you don't have any that can move and get where they need to be, the viability of things, so to speak, and then the morphology, the shape, if they're not the normal shape where they're not going to travel in a uniform way . . . there are a lot of things that go into a sperm test.

And so when we do a semen analysis at the University of Utah in our lab, we get the volume of the semen. It tells us the total sperm count, the sperm concentration, or how much there is per milliliter that's in the sample that we received. It tells us the viability, how many of those are alive and moving. It tells us the motility, how many of them are moving in an adequate amount to be beneficial for you. And then the shape and morphology. So it really gives us a lot more information.

However, the biggest thing I find for most patients is fertility may not be covered under their insurance. So they're looking for a quick test that can give them some information. And that test may or may not be helpful for them because if there is another aspect to the semen parameters that's not good, that's not just the number, then they're never going to see that on the test.

And so I think a lot of people are looking for a cost-effective way to just get some answers, but sometimes the most cost-effective way is just to come in and get a full semen analysis done with a fertility specialist.

Interviewer: Yeah. That way you can discover exactly what the issue is, and then go about perhaps solving that issue if there is indeed an issue.

Dr. Smith: Exactly.

Interviewer: So, from a male perspective, when you get this information back, generally then when you start solving the problem, is it going to be an expensive process or sometimes are there some simple changes that can be made that can make all the difference?

Dr. Smith: It's different for every patient. Some guys come in and they have a hormone-related issue that we can solve with some medication. That can really be an inexpensive fix. Oftentimes a lot of medications are still covered by insurance, which can be helpful.

And then in some men, if there is an issue where there is a low sperm count or no sperm count, some of the procedures to check and see if the testicles have viable sperm in them can be a little bit more expensive.

However, the real expense comes if you had to have IUI or IVF, which are insemination techniques. Most of the male stuff tends to be less expensive than that.

Now, again, when you're looking at things, fertility is not cheap by any stretch of the imagination. A lot of the procedures that are done to check for viable sperm within the testis can run anywhere from $2,000 to $5,000, but then a round of IVF can cost greater than $10,000 upwards, even much more than that.

So, when I talk about cost, it's very interesting because the male side of things generally is a skosh less expensive than the total amount that it takes to get the fertility solved in some cases.

Interviewer: So it is possible that you go and you get the test, you get some solid results, and it might be an inexpensive fix. That is not unheard of.

Dr. Smith: No, not at all, and we do a lot of that. And sometimes if the sperm count looks maybe borderline, we can also try some medication to try to bolster that sperm count for a few months and then do a retest type of thing.

And so a lot of times, we usually don't run right to the higher dollar surgical procedures, things like that, unless they're absolutely needed because we do understand that a lot of times this stuff isn't covered by insurance and we want to try to make it as best we can and most cost-effective for these folks.

It's a tough road. Fertility is tough. I see quite a few folks who we have success with, and it's great to see that, but any of those couples that are having trouble, I would say just get in and see if there's something that can be done to really help you because sometimes it is a simple solution.

Fertility can be one of the toughest portions of a relationship, but also one of the most rewarding. So I would say don't delay. Just get in and see if there is something that can be done to make things easier for you.

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Interviewer: When it comes to vasectomy, there are a lot of myths that you might hear about from friends or maybe you've even read them on the internet and they're simply not true. And a lot of times, these myths could contribute to the fact that maybe not as many men get a vasectomy in the United States compared to other parts of the world.

Dr. Alex Pastuszak is a urologist and a reproductive expert at University of Utah Health. And I'd love to get you as the expert to address some of these common myths that I found out on the internet about vasectomy and find out if they're true or not. I think one of all them that you hear is it's called getting snipped sometimes, which makes me think that this is a pretty major surgical procedure. Is that true?

Dr. Pastuszak: Great first question, great leading question. And ladies and gentlemen, I'm here to tell you that this is one of the least invasive procedures that a guy can have or a human being can have for that matter, because literally we're talking about two half-inch incisions, one or two half incisions in your scrotum and a quick pulling up of your vas -- clipping, cutting, putting it all back in there and suturing it up. All of this takes 15 minutes, very quick, not invasive.

Interviewer: All right. So getting snipped, that's really unfortunate isn't it that people refer to it as that?

Dr. Pastuszak: I mean it is factually correct, but it's not invasive.

Interviewer: Yeah, okay. What about this myth? It's really, really painful. Oh, it's going to hurt.

Dr. Pastuszak: Not true. If we did it back the way they would have done it back in the 1200s or 1400s before there was any form of anesthesia, then yes, maybe. But we use really good local anesthesia. We give you some oral meds that also numb things up a little bit for you. So the pain scale here is really minimal.

Interviewer: All right. And what about recovery pain? Sometimes I hear that it can be kind of painful to recover?

Dr. Pastuszak: Yeah. You know, I'll be frank with you. I tell guys to expect that, you know, they will feel like they got kicked in the boys for a day or so, on and off, so it's not constant and then that goes away.

Interviewer: All right. And that's really kind of a small price to pay when you think about it that from then on out, for the rest of your life, you don't have to think of birth control for you and your spouse?

Dr. Pastuszak: Think about the freedom that comes with a minor bit of pain for a day or two.

Interviewer: Absolutely. All right. What about this myth? It will affect my testosterone production, and all of a sudden I'm going to start watching "Gilmore Girls" and I'm going to have a high-pitched voice. My muscles are going to go away.

Dr. Pastuszak: Two words -- not true. Now, let me say just a word about that, because I think it's important. Okay? So guys, testosterone doesn't come up through your vas up into your body. It goes into your bloodstream. Your testicles make testosterone. Doing a vasectomy is not going to stop your testicles from making testosterone. Your testosterone levels may go down as you get older, but this has nothing to do with whether or not you had a vasectomy.

Interviewer: All right, that's good. What about this one? It's going to change sexual function or it's going to reduce a man's pleasure.

Dr. Pastuszak: Not at all. Your penis stays the way it was before vasectomy. And testosterone is really important in all those processes and, just like we said, we're not messing with that.

Interviewer: The key thing I'm picking up here is it's what are we actually doing, and we're just cutting that one little small tube that allows the sperm to go out into the world.

Dr. Pastuszak: That's right.

Interviewer: What about this one? This is a little bit more serious. It can cause prostate cancer, or it has been linked to cardiovascular disease if you get this procedure done.

Interviewer: There is no convincing evidence right now. There have been a couple of papers, but there is no evidence that would really suggest that vasectomy actually causes prostate cancer or is related to cardiovascular disease. These studies were all based on big cohorts that were not necessarily vetted very well. So there were imperfections in these studies, and in the urologic community right now, there's nobody who has changed practice as a result of any of them. So proof is certainly not 100% or even close to it.

Interviewer: It sounds like perhaps other things could have caused these things, not vasectomy in the data.

Dr. Pastuszak: Right. You know, guys will get prostate cancer as they get older.

Interviewer: That's just going to happen.

Dr. Pastuszak: It's just going to happen, exactly. Same thing with cardiovascular disease. Just because you link it to a vasectomy doesn't mean it's true.

Interviewer: And finally, how about this one that my sperm is going to build up? Now I'm saying this is just what I found on the internet. I mean, I don't know how somebody believes this, but apparently somebody does. My sperm's going to build up, and my testicles will explode as a result.

Dr. Pastuszak: So that, that's one of my favorites. And it's a legitimate question, right, because you are blocking the exit of sperm from the testicles.

Interviewer: And as high schoolers we know what that did.

Dr. Pastuszak: Right. Exactly, the blue and five letter word after that. The answer to this is that know your boys are not going to explode after you have a vasectomy. The body just reabsorbs the sperm that are made in your testicle. I mean, it knows that they have nowhere to go, and then it's just going to soak them right back up. So don't worry about it.

Interviewer: All right. Any other myths out there?

Dr. Pastuszak: You know, I think you've covered it pretty well. I did also just want to touch on the orgasm one, because we talked a little bit about sexual function and we talked about sensation but not orgasm. No effect on orgasm either. Guys, just be reassured that this is a very local thing that we're doing. We're going to keep you from having babies in the future, and it's not going affect anything that you associate with your sexuality, manhood or your livelihood.

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