Enhanced Male Fertility Screening Tests

The latest advances in the field of assisted conception suggest that we need to measure men’s fertility more accurately. A growing problem around men’s fertility was highlighted in 2017 when scientists reported that the sperm count of men in the developing world had more than halved over the last 40 years.

To make sure we are able to fully investigate any potential issues around sperm health, the Agora has developed an Enhanced Male Fertility Screening package. This offers four additional sperm tests beyond the routine semen analysis offered by the NHS. The tests include:

  • Sperm count
  • Sperm motility (or movement)
  • Sperm morphology
  • DNA fragmentation test
  • Hyaluronan Binding Assay (HBA) test
  • Oxidative stress
  • Sperm and urine infection screen

This comprehensive package enables us to have a much better understanding of sperm health and the capacity of the sperm to fertilise eggs.All our testing is completely non-invasive – no injections or medical procedures are required – we only need a sample of sperm.

The results we get back from our laboratory help us make the correct diagnosis and fine-tune any treatment to make sure the best possible results are achieved. A 15 minute consultation is included in this package.

The DNA Fragmentation Test

As the health of the sperm links to the health of the embryo, it’s not surprising that high levels of sperm damage – known as DNA fragmentation and measured by the DNA Fragility Index (DFI) – have been linked to lower success rates in all assisted conception treatment cycles. In other words, the DFI is a good indicator of the reproductive potential of sperm and is detected by the latest high precision technology – known as flow cytometry. Where the DFI is recorded at more than 15% (meaning that more than 15% of the sperm are damaged) the success rates of fertility treatment are likely to be lower.

High levels of DNA fragmentation have been found in couples given a diagnosis of ‘unexplained infertility’ as well as in those who have had repeated failed IVF cycles despite producing good embryos. Sperm damage has also been linked to miscarriages.

The DNA Fragmentation Test is also offered as a stand-alone test. 

Who may be affected by DNA fragmentation?

Most sperm contain at least a small amount of sperm with DNA fragmentation. This damage can be caused by a number of factors including diabetes, infection, diet, smoking and obesity.

What can be done if the DFI results are high?

The DFI is measured as the percentage of sperm with DNA damage. 

  • DNA damage is considered ‘normal’ when DFI is less than 15%
  • ‘Moderately elevated’ is when the DFI is 15-25%
  • ‘High’ is when the DFI is more than 25%
  • If the DFI is more than 15% this can be linked to reduced success rates with IUI and IVF, multiple failed IVF/ICSI treatments and increased miscarriage risk. It may also be a cause of ‘unexplained infertility

When we get the results back, we will talk to you about ways of reducing the DFI to increase the chances of a successful pregnancy. These can include lifestyle changes such as:

  • Losing weight
  • Reducing alcohol intake
  • Stopping smoking

In some cases, you may also be advised to take supplements with antioxidant properties, which cause no symptoms, can significantly affect sperm health.It takes about three months to form mature sperm, so a change in the DFI can usually only be measured 3-6 months after any of the interventions listed above. In cases of high DFI, we may also advise fertility treatment with ICSI.

Why do we test for oxidative stress?

Measuring Oxidation Reduction Potential (ORP) is the latest advancement in male infertility diagnostics. This is achieved using Mioxsys, an advanced system that detects anomalies in sperm which are strongly associated with‘unexplained infertility’. Elevated levels of oxidants and reductants can impair the sperm due to lipid peroxidation, DNA and protein damage. Multiple factors are responsible for increased levels of oxidative stress in sperm, as shown in the diagram below.

What is Hyaluronan Binding Assay (HBA)?

The HBA measures the maturity of sperm in a fresh semen sample to diagnose suspected male infertility. The test looks at the ability of the sperm to bind to the egg (oocyte). The HBA test predicts the ability of sperm to fertilize eggs and can help us to advise you about whether treatment with IVF or ICSI is more likely to be successful. It can be particularly useful in cases of unexplained infertility.Why do we test for infectious agents?

Sperm and urine infection screen detects potential pathogenic microorganisms (bacterial or other agents), which could impair sperm health. Also, this test is beneficial for providing an insight into the reproductive health of the male. Any pathogenic microorganism can be detected with this test. If a causative agent is identified in this test, you may be prescribed a course of antibiotics before starting your treatment.

What does the test involve?

Please arrive in the clinic with a comfortably full bladder and we recommend you abstain from sexual activity for 2- 5 days. You will need to produce a sperm and urine sample. We will then prepare, freeze part of it and send to our diagnostic laboratory where it is analysed.

Next steps

You will receive your results within two – three weeks, as well as advice on the next steps. If the tests show that further treatment is required to reduce the DFI, oxidative stress and/or infectious agent(s), you will be offered a 15- minute telephone or Zoom consultation by a fertility expert and/ or referred to a consultant urologist.


The Enhanced Fertility Screening Package (single male only) is £495
(this includes semen assessment, DNA Fragmentation, HBA Sperm Binding, Oxidative stress, semen and urine infection screening and where required a 15 minute consultation to discuss next steps).

The DNA fragmentation test (which can be done without the other tests) is £160.
If you’d like to know more about this new package of tests or to book a consultation, please contact us.

What is an Enhanced Male Fertility Assessment?

An enhanced male fertility assessment involves more detailed male fertility tests.

It includes some additional tests of sperm health and function. And it gives a far greater insight into your reproductive health.

It can be very helpful if previous or home sperm tests have been normal and your infertility remains ‘unexplained’. Or when these tests have been abnormal but you have not been given an explanation as to why.

Sperm DNA fragmentation (SDF) is known to be higher in infertile men. Testing for Sperm DNA fragmentation measures the quality of sperm as a DNA package carrier, and it therefore is more significant than the parameters analysed in standard semen analyses.

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