Comparing remote smartphone-based semen assessments with laboratory evaluations in men unselected for fertility concerns

OBJECTIVE: To evaluate the quality of remote semen collection and a smartphone-based semen analysis system under real-world conditions compared with a laboratory assessment among participants who were unselected for fertility status. DESIGN: Prospective study. SUBJECTS: A total of 150 men unselected for fertility status who participated in the Reproductive Effects of Chemicals and Air Pollution (RECAP) study. EXPOSURE: Participants performed remote smartphone-based semen analysis and sent samples to a fertility center laboratory. MAIN OUTCOME MEASURES: Agreement of sperm concentration and motility using a smartphone-based analyzer and delayed evaluation in the andrology laboratory. RESULTS: Of 150 men who provided a semen sample analyzed remotely or at the laboratory, 92 had both usable smartphone and delayed Computer-Assisted Sperm Analysis (CASA) results. The median time (interquartile range) between semen collection and delayed laboratory assessment was 29.9 (26.5-32.3) hours. The median sperm concentrations were 83.0 million/mL by smartphone and 50.7 million/mL by delayed CASA assessment. The median total motility was 36.5% by smartphone and 4.5% by delayed laboratory assessment. The Bland-Altman plots comparing the smartphone analyzer with delayed laboratory assessment for sperm concentration and total sperm count suggest that differences between the 2 methods were higher as sperm concentration increased. Smartphone-based measures were highly reproducible for concentration (intraclass correlation coefficient, 0.98) and motility (intraclass correlation coefficient, 0.90). Smartphone-based systems had high specificity (86.2%) and negative predictive value (93.8%) for identifying men with low sperm concentration (<16 million/mL, n = 5) by laboratory assessment. There was a suggestion that sperm motility measured by smartphone was inversely associated with the probability of having no motile sperm in the delayed laboratory assessment. CONCLUSION: Smartphone-based systems are a comparable option to a single laboratory-based CASA measurement and have logistical advantages for research studies and potentially as a clinical screening tool among men in the general population. Further studies are warranted to confirm their effectiveness and broader utility.