Because semen analysis is the primary diagnostic tool in male fertility investigations, we assessed its performance in clinical laboratories. We randomly surveyed United States hospital laboratories to determine the factors that predict demand for semen analysis and to assess the technical caliber and quality of semen testing performed. Hospital size, presence of a fertility center in the hospital, reproductive care physicians ordering the test, and quality of testing are factors that predict semen analysis demand. Our study also revealed that, in spite of increased demand for semen analysis, testing is not comprehensive, technology is minimal, and quality is compromised. Most clinical laboratories do not offer a quality semen analysis sufficient for diagnosing infertility.