Quality and Accessibility of Consumer Information for Commercially Available At-Home and Mail-In Semen Analysis Products
John Ernandez, BA1, Grayden Cook, MD1, Brittany Berk, MD1, Jane Kielhofner, BS2, Alexandra J. Berger, MD1, Martin Kathrins, MD1.
1Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA, USA, 2Harvard Medical School, Boston, MA, USA.
INTRODUCTION: At-home and mail-in semen analysis (SA) services obviate barriers that deter men from clinic testing and have made recent strides in providing higher quality data. However, the American Urological Association (AUA) and the American Society of Reproductive Medicine (ASRM) have not made formal recommendations on these services. Herein, we investigate the quality and accessibility of consumer information on these products.
MATERIALS & METHODS: Using Google search terms "at-home sperm test" and "mail-in sperm test", we identified commercially available SA products, excluding those only offered to providers, providing only genetic information, or designed for use after vasectomy. We determined which semen parameters each service offered; if the service was validated in subfertile men and against an established SA method; and if the service provided guidance to consumers in accordance with AUA/ASRM guidelines. The accountability and aesthetic appearance of online content for each SA were assessed using the Silber accountability score and modified Abbott's criteria, respectively. The readability of information was assessed using the Flesch-Kincaid score. Descriptive statistics and two-tailed t-tests were used to compare SA characteristics, with p < 0.05 as statistically significant.
RESULTS: We identified 17 commercially available at-home (n = 15) and mail-in (n = 2) SA services with an online, consumer-facing presence (Table 1). At-home tests varied in their method of SA, including colorimetric (n = 7), microscopic/microfluidic (n = 7), and centrifugation systems (n = 1). 89% of tests reported sperm concentration, with the majority reporting concentration qualitatively. An additional 53% and 11% of tests reported motility and morphology, respectively. While a majority of tests recommend consumers to abstain from sexual activity before testing (63%), fewer than half recommend men perform more than one test (47%) and none highlight the need for partner evaluation for >6-12 months of difficulty conceiving. While two-thirds of tests are validated against a gold standard, only 26% were validated among subfertile men (Table 1). The median Silber accountability score was 4 (interquartile range (IQR) 1-5), with most websites lacking information on their credentials, sponsors, and disclosures, though most were aesthetically pleasing. Consumer-facing information on product indications and use had a Flesch-Kincaid score of 50 ± 14, suggesting that high-school-level comprehension is required. Readability did not differ significantly by method of SA (Table 2).
CONCLUSIONS: At-home and mail-in SA products most commonly report sperm motility and concentration, however, inconsistently provide clinical recommendations around testing in accordance with guidelines. Additionally, while consumer-facing online content for commercially available SAs is on average aesthetically appealing, it may lack accountability and require a higher level of education for comprehension. Formal recommendations on the content and use of home SA products may improve the quality and accessibility on these products. 
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