Houston Methodist Pioneers Semen Analysis as a Broader Health Screening Tool

In an era where preventive health care is rapidly gaining momentum, Houston Methodist is emerging as a leader in an unexpected yet promising field: semen analysis.

Under the guidance of Dr. Akhil Muthigi, co-director of the Fertility and Reproductive Medicine Program and director of the Male Fertility Clinic, Houston Methodist is exploring the potential of andrology analysis as a diagnostic tool not just for fertility, but for overall male health.

Traditionally, analyzing semen has been confined to evaluating male fertility. However, emerging research indicates that the noninvasive test can offer insights into a range of chronic health conditions, including cancer, diabetes, cardiovascular disease, metabolic disorders and even psychological health.

"Similar to a urinalysis, semen analysis is a naturally produced bodily fluid test that can relay important information about underlying health conditions," Dr. Muthigi says. "Our vision is to transform this fertility-focused test into a routine health screening tool for men, potentially akin to annual blood work or periodic pap smears."

Dr. Muthigi and his team are at the forefront of turning these insights into actionable diagnostic tools. He recently sat down with Leading Medicine to discuss Houston Methodist's role in the emerging field.

Q: What have we learned so far about the connection between male infertility and general health?

Dr. Muthigi: Recently my colleagues and I published a perspective article in the International Journal of Impotence Research highlighting the growing evidence linking male infertility with chronic health conditions. Infertile men are at significantly higher risk for metabolic disorders, cardiovascular disease, and even specific cancers such as prostate and testicular cancer. Our findings revealed that semen quality is not only a marker of reproductive health but can also provide a window into systemic health.

One study cited in the research showed that infertile men had a 30% higher risk of diabetes, a 48% higher risk of ischemic heart disease and alcohol use disorder and 67% higher risk of drug abuse compared to their counterparts with normal fertility profiles. These findings underscore the importance of semen testing as a screening tool that goes far beyond assessing sperm count and motility for the purposes of fertility and family planning.

Importantly, male factor infertility was found to be a predictor of future development of these conditions. Direct causality is often difficult to establish, however, as chronic conditions take years to develop, and therefore a higher incidence with longer follow-up indicates that these conditions may not have been present or prominent before the diagnosis of infertility.

Q: How was it discovered that semen could be analyzed for more than fertility?

Dr. Muthigi: Over the last five to ten years, research has started to uncover connections between male infertility and chronic conditions such as diabetes and cardiovascular disease. I became interested in this line of research during my urology fellowship, when I came across an early study showing that infertile men had a higher risk of developing certain conditions over time. This led me to propose the utility of semen analysis as a broader health screening tool.

Q: How is Houston Methodist leading this effort?

Dr. Muthigi: We recently launched a fully equipped andrology lab capable of advanced semen testing, including DNA fragmentation index testing, sperm aneuploidy testing and anti-sperm antibody analysis. These state-of-the-art tools allow for more comprehensive diagnosis and management of male factor infertility. Our goal is to use this lab to screen young and healthy men through an IRB-approved study to correlate semen abnormalities with chronic disease risk, as a "proof of concept" for adding this diagnostic test to the repertoire of preventive health screenings.

Q: How does semen analysis compare to existing screening or diagnostic tests?

Dr. Muthigi: While we can't definitively say semen abnormalities lead to chronic conditions, we do know infertile men have higher risks of developing issues like diabetes, heart disease and even depression.

A large part of the value proposition lies in the test's safety, cost-effectiveness and noninvasive nature, as well as in its broad applicability. You need certain clues to tell you that you should go to a cardiologist and have your heart checked out, right? But, often, those clues don't show up until damage has been done.

Semen testing could become a routine health tool ordered by primary care providers, assuming the patient hasn't had a prior vasectomy. It may not need to be performed annually, but periodic testing, similar to pap smears and colonoscopies, could help detect early signs of chronic conditions and prompt preventive care.

Q: Is Houston Methodist the first to pioneer this approach?

Dr. Muthigi: That is our goal — to be the first to establish semen analysis as a routine diagnostic screening tool for overall health. We're poised to set a new national precedent in men's health and male infertility.

Beyond expanding the traditional role of andrology, we are really ramping up our research efforts to identify novel connections between abnormal semen test results and specific health conditions. Future studies will focus on identifying genomic and proteomic markers associated with infertility and chronic diseases. Additionally, we plan to develop targeted intervention strategies based on our findings.

With the integration of innovative technologies, such as those in our recently opened andrology lab, and initiating a groundbreaking clinical trial to understand the clinical utility of semen analysis as an indicator of general health, we are leaning into the concept that leading in men's health is leading medicine. We think these insights could have important implications for public health and personalized preventive care as we work towards pioneering, studying and refining a novel clinical practice.