Joshua Halpern, MD, MS, on the clinical role of mail-in semen analysis

In the following interview, conducted at the 2026 American Urological Association (AUA) Annual Meeting, Joshua Halpern, MD, MS, discusses the evidence supporting the clinical reliability of mail-in semen analysis and highlighted the patient populations most likely to benefit from at-home testing. Halpern is the regional medical director in the Northeast and chief scientific officer for Posterity Health. He is also an adjunct assistant professor of urology at Northwestern Medicine.

Halpern explained that a growing body of evidence supports the accuracy of mail-in semen analysis, despite known limitations related to sperm motility during sample transport. He references a 2021 study that demonstrated a predictable decline in sperm motility over time after sample collection, enabling investigators to develop an algorithm that estimates motility at the time of sample production.¹ Subsequent studies have built on these findings, including a 2024 investigation that compared in-clinic semen analyses with repeat analyses performed after samples were shipped to an off-site laboratory. According to Halpern, the study found strong concordance between the pre-shipping and post-shipping results,² providing encouraging evidence that mail-in testing can offer a reliable assessment of semen parameters.

Although Halpern emphasized that mail-in testing is not a perfect substitute for traditional laboratory evaluation, he said it provides clinically meaningful information for many patients. He noted that one of the greatest advantages is improved access for men living in areas without nearby reproductive urology or semen analysis laboratories. For patients who would otherwise face lengthy travel to obtain testing, mail-in semen analysis can help overcome geographic barriers and facilitate earlier evaluation.

Halpern also outlined several clinical scenarios in which at-home semen testing may be particularly valuable. He suggested that men who are preparing to conceive and want an initial fertility assessment before pursuing a full infertility workup may benefit from the convenience of mail-in testing, whereas couples with established infertility are generally better served by comprehensive in-clinic diagnostic evaluation. He also highlighted post-vasectomy semen analysis as an especially impactful application, explaining that patient compliance with follow-up testing has historically been poor. By allowing patients to submit samples from home, mail-in testing can improve adherence to recommended follow-up, an approach that is now recognized as an acceptable option in the most recent AUA vasectomy guideline.^3,4

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