Mail-in Semen Analysis Completion Among Men Seeking Fertility Evaluation

INTRODUCTION: One in 6 couples experience infertility, and male partner evaluation is often delayed or incomplete. Mail-in semen analysis (SA) may reduce logistical barriers to testing, but completion among fertility patients who use this pathway is not well characterized. METHODS: This prospective cohort study included 35,444 patients who obtained a mail-in SA kit from a single national commercial platform (Fellow Health) between April 2020 and October 2025 for fertility evaluation. Completion was defined as receipt and analysis by the laboratory within 16 weeks of kit activation, the step at which a kit is linked to an individual patient and standardized reminders begin. Age, geographic region, neighborhood socioeconomic deprivation (Area Deprivation Index [ADI] quintile), urbanization, and time point in the fertility journey were evaluated. Multivariable logistic regression and complete-case sensitivity analyses were performed. RESULTS: Overall SA completion was 93% at 16 weeks (32,955/35,444), with 81% completed within 4 weeks and 89% by 8 weeks. Younger age was associated with higher completion (p<0.001). There was not a statistically significant association between completion and urbanization (p=0.24) or ADI quintile (p=0.79), and absolute differences across these categories were small. In multivariable analysis, men trying to conceive for 0-6 months and 7-12 months had 27% and 34% higher odds of completion, respectively, than men planning to start trying in 1 year or longer. CONCLUSIONS: Among patients who activated a mail-in SA kit for fertility evaluation, completion was high across geographic, urbanization, and neighborhood socioeconomic categories. Nearly one-third of men sought testing before meeting guideline criteria for infertility evaluation, indicating interest in earlier information about fertility status. These findings describe completion within a single mail-in SA pathway and do not compare it with other testing options; this observational study does not establish causality compared with clinic-based testing and did not evaluate real-world analytical accuracy.