From Test Offer to Urologic Follow-up: Acceptability of Semen Analysis in Male Infertility and Preconception Care

Semen analysis is a basic component of male infertility evaluation and can serve as an entry point to male reproductive health and couple-based fertility care. However, its acceptability is shaped by features that differ from many routine laboratory tests, including the private and sexual nature of specimen collection, abstinence and timing requirements, privacy concerns, result anxiety, stigma, and uncertainty about clinical follow-up. This targeted narrative review synthesizes clinical, behavioral, psychosocial, technological, and Japanese-context evidence relevant to semen-analysis acceptability in male infertility and preconception/couple care. Rather than proposing or validating a new acceptability model, it presents an author-developed, provisional nine-stage map of semen-analysis service events: information reach, comprehension, self-relevance, emotional safety, collection feasibility, informed decision, sample submission, result interpretation, and care connection. It uses established acceptability and health-behavior concepts to interpret where attrition may occur. The map is conceptual and hypothesis-generating; its stages, boundaries, and candidate measures require prospective operationalization and validation. This pathway reframes low uptake or noncompletion as possible attrition before, during, or after testing, rather than as simple refusal. Evidence suggests that barriers may include limited fertility knowledge, fertility being framed as a women’s issue, embarrassment, fear of abnormal results, stigma, collection logistics, and unsupported result return. Potential stage-specific responses include private and plain-language communication, non-shaming framing, feasible collection options, contextual result explanation, repeat-testing guidance, and referral to urology or male infertility care when indicated. Home collection and home-based or point-of-care tools may reduce procedural barriers, but they should not become unsupported endpoints without interpretation and care linkage. Improving semen-analysis acceptability should support informed, voluntary, unashamed, and clinically connected decision-making within equitable couple care.