Pearls & Perspectives: Modern Semen Testing and Male Fertility Care, with Thomas Masterson, MD

In this special Urology on the Beach edition of Pearls & Perspectives, host Amy Pearlman, MD, speaks with Thomas Masterson, MD, assistant professor of clinical urology at Desai Sethi Urology Institute in Miami, Florida, about emerging tools and evolving concepts in male infertility and men’s health, with a focus on what lies beyond the traditional semen analysis.Masterson explains that although semen analysis remains the cornerstone of male fertility evaluation, it only assesses external sperm characteristics—concentration, motility, and morphology—and provides limited insight into the genetic integrity of sperm. DNA fragmentation testing offers a window into the quality of the DNA carried by sperm and may help identify potentially correctable contributors to recurrent pregnancy loss, repeated in vitro fertilization failure, and cases of unexplained infertility.The conversation explores the growing role of at-home semen testing kits as screening tools, their advantages in accessibility and privacy, and their limitations compared with in-lab testing—particularly for detecting very low sperm counts and accurately assessing motility. Masterson emphasizes the importance of establishing a baseline semen analysis in men considering or already receiving testosterone therapy, as exogenous testosterone commonly suppresses sperm production and can complicate later fertility evaluation.Pearlman and Masterson also discuss advanced paternal age, noting that although men can produce sperm throughout life, sperm quality may decline over time, with small increases in risks such as autism and certain genetic conditions. Options such as sperm cryopreservation are reviewed as a consideration for select men, particularly those facing gonadotoxic therapies.Beyond fertility, the episode touches on erectile function as a general marker of health, the limitations of using morning erections as a diagnostic tool, and the broader need to normalize conversations around male sexual health. The discussion closes with reflections on gender differences in health-seeking behavior and the importance of creating spaces that encourage men to engage more openly in discussions about sexual and reproductive health.