PROVISION OF MAIL-IN AT-HOME SEMEN ANALYSIS KITS IN CLINIC IMPROVES TEST COMPLETION RATES.

Patients undergoing semen analysis (SA) face barriers to care including long distance from testing facilities, time constraints, and health illiteracy. Recent data showed that 90% of patients believed that at-home testing would improve completion rates. The objective of this study was to evaluate sociodemographic and clinical factors impacting at-home mail-in SA completion rates. Patients planning at-home mail-in SA through Fellow Health obtained kits online or directly from a clinic. Patients were invited to participate in an IRB-approved survey regarding their background, indications for testing, and medical history. Bivariate and multivariate logistic regression analyses were performed to assess the impact of mode of acquisition and sociodemographic factors on completion rates. A total of 2,428 patients ordered kits online or registered clinic kits between late 2021 and 2023 and consented to participate in the survey. Patients obtained kits to assess the success of their vasectomy, their fertility, or to cryopreserve sperm. Seventy-five percent (n=1814) obtained kits directly from a clinic, and 25% (n=614) ordered online. Seventy-nine percent completed testing, meaning they mailed their sample to the laboratory and had a valid SA result; the remaining 21% of patients did not return their kits or had a missing result on first attempt (e.g., due to sample collection or shipping issues). Eighty-eight percent were referred by urologists. Seventy-four percent underwent testing post-vasectomy, and 8% underwent testing for infertility. Completion was higher among patients obtaining kits via clinic provision versus online order (91 vs. 41%, p<.001), White or Black vs. Native American or Pacific Islander (p<.05), higher income (p<.05), insurance coverage for over 50% of the cost (p<.05), or those from the Midwest (p<.05). Patients were less likely to return a semen sample if they were seeking fertility versus post-vasectomy assessment (p<.01). There were no significant differences in the odds of completion by age or marital status. On multivariable analysis, the odds of completion remained much higher among patients obtaining kits in clinic vs. online (OR: 15.2, 95% CI: 12,20), among patients from the Midwest vs. other regions (OR: 1.5, 95% CI: 1.03,2.09), and among patients with greater than 50% insurance coverage compared to no coverage (OR: 2.6, 95% CI: 1.3,5.4). The odds of completion were lower among patients undergoing testing for fertility compared to post-vasectomy (OR: 0.40, 95% CI: 0.32,0.53). The majority of patients utilizing at-home semen analysis testing kits successfully complete testing. Patients were more likely to complete SA testing if they were provided with the kit in clinic than if they ordered online. Completion rates also varied by indication for testing, race, geography, and insurance status. Clinic provision of testing kits particularly for fertility testing may be an impactful strategy for addressing health disparities surrounding SA completion.