Barriers and attitudes toward semen testing among males planning or attempting to conceive

Male-factor infertility contributes to approximately 50% of infertility cases among couples, and semen analysis remains the cornerstone of initial evaluation. Despite clinical guidelines from the American Society for Reproductive Medicine recommending timely assessment (1), a substantial proportion of males, including those at risk for infertility, do not undergo diagnostic evaluation. Although numerous potential barriers to male fertility care have been identified (e.g., educational, cultural, stigma, geographic, financial, and many others) (2), little is known regarding the specific barriers that prevent males from pursuing semen testing. This study aimed to assess attitudes toward semen testing and fertility support among males trying to conceive.

Study design

A descriptive analysis was conducted using data from a web-based survey (Centiment; Denver, CO) evaluating attitudes and behaviors related to male fertility testing and support. The survey was administered in English to heterosexual males aged 25–49 years who were employed, living in the United States, had private health insurance, and were either actively trying to conceive (TTC) or planning to conceive. Responses were collected between March 7–16, 2025. Centiment, a company that provides access to online survey panels, recruited respondents who met the eligibility criteria for all characteristics except TTC status, for which Centiment did not have information. Assessing eligibility on the basis of TTC status occurred within the survey, which included a question about intent to have biological children. To avoid biasing the sample by recruiting people with an interest in this topic, the survey topic was not included in recruitment materials. For this analysis, we restricted the sample to males who had never undergone semen testing.

Respondents provided demographic and fertility-related information and answered questions assessing: likelihood of pursuing semen testing; reasons for not testing; perceived stigma surrounding testing; and preferred testing location. In addition, respondents reported what actions they would take upon learning of a fertility issue and which digital health resources they would find helpful. Data were analyzed descriptively. This study was deemed exempt by the WCG institutional review board, an independent ethics review board.

Results

Of 1,087 respondents who started the survey, 542 were disqualified for not meeting the survey eligibility criteria. Of the remaining 545 respondents, 529 completed the survey for a completion rate of 97.0%. Among the 529 total respondents, 340 met the additional study inclusion criteria of never having undergone semen testing. A majority were aged 30–39 years (n = 194, 57.1%), White (n = 217, 63.8%), did not have biological children (n = 245, 72.1%) and, among those currently TTC, had been TTC for <6 months (n = 69, 51.5%).

Nearly half of the respondents reported being likely or extremely likely to pursue semen testing (n = 167, 49.2%), and were open to testing at a doctor’s office (n = 158, 47.4%), at home (n = 100, 30.0%), or in either location (n = 75, 22.5%). The most commonly cited barriers to testing included cost (n = 168, 49.4%), confidence in their fertility (n = 132, 38.8%), and fear of the results (n = 98, 28.8%). Nearly half (n = 168, 49.4%) perceived there to be a stigma associated with semen testing (Table 1).

Table 1.

Attitudes toward semen analysis and fertility support.

Attitudes and behaviors	n (%) (N = 340)
Likelihood of doing a semen test without a specific recommendation from a health care professional:
Extremely likely	41 (12.1%)
Likely	126 (37.1%)
Unlikely	136 (40.0%)
Extremely unlikely	37 (10.9%)
Preferred location for semen testing:∗
Doctor’s office	158 (47.4%)
At home	100 (30.0%)
Either the doctor’s office or at home	75 (22.5%)
Reasons for not doing a semen test
The cost	168 (49.4%)
Feeling confident that I am fertile	132 (38.8%)
Fear of the results	98 (28.8%)
Feeling uncomfortable performing the test	92 (27.1%)
The inconvenience or difficulty of arranging the test	65 (19.1%)
None of the above	30 (8.8%)
Semen testing is stigmatized:
Yes	168 (49.4%)
No	172 (50.6%)
Action that would be taken if a fertility problem was identified:†
Look into improving my fertility on my own	195 (62.9%)
See an in-person healthcare provider	156 (50.3%)
Connect with a healthcare provider on a virtual health care platform	131 (42.2%)
Digital health resources of interest for supporting fertility:‡
Articles	172 (50.6%)
Messaging with healthcare providers	170 (50.0%)
Video calls with healthcare providers	139 (40.9%)
Classes	91 (26.8%)
Community forums to connect with other males	85 (25.0%)
None of the above	42 (12.4%)

^∗Only includes respondents who selected a preferred testing location (n = 333).

^†Only includes respondents without a known fertility issue (n = 310). Respondents could select all that apply.

^‡Respondents could select all that apply.

When asked how they would respond to a potential fertility issue, the majority reported they would attempt to improve fertility on their own (n = 195, 62.9%). Many also indicated they would seek support from a healthcare provider, either in person (n = 156, 50.3%) or through a virtual health platform (n = 131, 42.2%). Interest in digital health tools to support their fertility was high, with 87.6% (n = 298) selecting at least one resource of interest. Asynchronous resources, articles (n = 172, 50.6%), and messaging with healthcare providers (n = 170, 50.0%) were of greatest interest (Table 1).

Conclusion

There is a high level of interest among males planning or actively TTC in pursuing semen testing and using additional resources to support their fertility journey. The most common barriers to testing are perceived costs, stigma, and assumptions regarding fertility status. To address these barriers, there is a need for multifaceted efforts to educate males about male infertility and semen testing during preconception and early attempts to conceive, and to destigmatize semen testing. With the growing availability of low-cost, easy-to-use home semen tests that do not require a prescription or doctor’s order (3, 4), along with digital resources to support male partners, options are available increasingly to empower males to take a proactive role in their fertility journey. We encourage the use of well-validated tests and recommend that tests provide clear and accessible information on their validity. Because the study was limited to employed individuals with private health insurance, and respondents were predominantly White and able to complete a survey in English, the results may not be generalizable to the broader US population. Further studies are needed to validate these findings in other populations and to determine the optimal timing, content, and delivery mechanisms for interventions to promote early education and testing of male partners planning for family building.

CRediT Authorship Contribution Statement

Natalie Henrich: Writing – original draft, Methodology, Formal analysis, Conceptualization. Hannah Jahnke: Writing – review & editing, Methodology, Conceptualization. Alison Brinson: Writing – review & editing, Methodology, Conceptualization. Jason Kovac: Writing – review & editing. Joshua Halpern: Writing – original draft, Methodology, Conceptualization.

Declaration of Interests

N.H. is an employee of Maven Clinic and has equity options in the company. H.J. is an employee of Maven Clinic and has equity options in the company. A.B. is an employee of Maven Clinic and has equity options in the company. J.K. is the Regional Medical Director of Posterity Health and has equity options in the company. J.H. is an employee of Posterity Health and has equity options in the company; and is an advisor for EngagedMD.