There is a fundamental mismatch at the center of how fertility care is structured in the United States. Male-factor causes contribute to roughly 40–50% of all infertility diagnoses — and in approximately one-third of cases, the male partner is the sole identifiable cause. Yet the clinical infrastructure built around fertility is overwhelmingly female-facing. Reproductive endocrinologists treat the woman. The man receives a semen analysis, perhaps a second one, and if the results are suboptimal, the couple is typically steered toward IVF with ICSI — a process that circumvents the male factor rather than investigating or treating it.
Posterity Health was built to close that gap. Founded in Englewood, Colorado and operating out of the Denver Tech Center, Posterity is one of the few companies in the country that has organized an entire clinical practice specifically around male reproductive health — combining the accessibility of telehealth with the surgical depth of fellowship-trained reproductive urologists. With a 4.9-star rating from 489 reviews, it has earned that reputation one appointment at a time.
A Different Model for Male Fertility Care
What makes Posterity Health structurally unusual is not simply that it focuses on men. It is that it has designed its model around the specific barriers that keep men from being evaluated in the first place: wait times measured in months, geographic distance from subspecialists, and the stigma that surrounds male infertility.
New patients can schedule with a male fertility specialist in under 72 hours — compared to six months or more for a standard reproductive urology referral. The at-home semen analysis kit, CLIA-certified and physician-approved, is shipped directly to the patient. The initial evaluation happens by video. A man can initiate a formal fertility workup without leaving home or navigating a referral chain. For couples pursuing IVF, where every delay carries both financial and biological cost, that efficiency is clinically meaningful.
The Clinical Team
Posterity Health describes itself as the largest practice of reproductive urologists and male fertility specialists in the country. Its physicians are fellowship-trained in male reproductive medicine — a subspecialty beyond standard urology residency that covers surgical sperm retrieval, varicocele repair, vasectomy reversal, and the hormonal management of male reproductive endocrinology.
Dr. Matthew Pollard, MD, trained at the Icahn School of Medicine at Mount Sinai, completed his urology residency at UCLA, and pursued a fellowship in Male Reproductive Medicine and Surgery at Baylor College of Medicine. Dr. Puneet Masson is a board-certified reproductive urologist who built the male fertility program at Penn Medicine. Neither is a generalist who added fertility as an afterthought.
The company was co-founded by CEO Pam Pure and Dr. Barrett Cowan, its chief medical officer and himself a reproductive urologist — meaning the clinical philosophy of the practice is embedded in leadership rather than delegated to an advisory board.
Services: From At-Home Testing to Surgical Sperm Retrieval
The service model is designed to meet patients wherever they are in the diagnostic and treatment continuum. It begins with testing that is genuinely accessible and extends to complex surgical procedures that require in-person care.
At-home semen analysis is the entry point for most patients. The kit provides a CLIA-certified result interpreted by a physician, not an algorithmic score from a consumer device. Patients receive a detailed consultation with a male fertility specialist to review results — the goal is clinical understanding, not just a number.
Sperm DNA fragmentation testing goes beyond conventional semen analysis to evaluate the integrity of the genetic material inside sperm. High DNA fragmentation is associated with recurrent miscarriage and poor IVF outcomes even when standard parameters look acceptable, making it an important diagnostic tool for couples who have already experienced pregnancy loss.
Varicocele evaluation and repair addresses the most common surgically correctable cause of male infertility. Varicoceles — dilated veins in the scrotum that elevate testicular temperature and impair sperm production — are present in roughly 35–40% of men evaluated for infertility. Posterity's physicians perform both conventional varicocelectomy and bilateral varicocele repair. When caught early and corrected surgically, varicocele treatment can meaningfully improve sperm parameters and, in some cases, reduce or eliminate the need for IVF.
TESA and PESA (testicular and percutaneous epididymal sperm aspiration) are surgical sperm retrieval procedures for men who cannot produce sperm through ejaculation — either because of a blockage or, in more challenging cases, because of a production impairment. Sperm retrieved through these procedures is used in IVF with ICSI. Posterity also performs testicular microdissection (micro-TESE) for men with non-obstructive azoospermia.
Vasectomy reversal is available for men who underwent prior vasectomy and have since decided to pursue biological fatherhood. Success rates are highly technique-dependent, and Posterity's fellowship-trained team has the case volume to back that up.
Hormone management rounds out the picture. Testosterone management requires particular care in the fertility context — exogenous testosterone can suppress sperm production, and men with low T who want to conceive need protocols that differ substantially from standard replacement therapy. Posterity's 2025-launched Hormone Management Program is designed for exactly this situation.
How Posterity Fits Into the IVF Workflow
For couples pursuing assisted reproduction, Posterity Health functions as a complement to — not a replacement for — a traditional fertility clinic. The female partner's reproductive endocrinologist manages ovarian stimulation, egg retrieval, embryo culture, and transfer. Posterity handles the male side of the equation: evaluating sperm, identifying and treating correctable causes, optimizing semen parameters before a retrieval cycle, and performing surgical sperm extraction when needed.
This division of labor matters because most IVF clinics are not staffed with fellowship-trained reproductive urologists. They can flag an abnormal semen analysis; they cannot reliably diagnose its cause, repair a varicocele, or perform a micro-TESE. A couple arriving at an REI with untreated varicocele and high sperm DNA fragmentation is not being served optimally. Adding a male fertility specialist — even just via telehealth consultation — changes the clinical calculus.
For Colorado couples, the insurance landscape is worth understanding. Colorado's Building Families Act (fully effective January 1, 2023 for large group plans) requires coverage of infertility diagnosis and treatment including IVF — but its protections apply only to state-regulated plans. Many Coloradans remain in self-funded ERISA plans that fall outside the mandate. Before committing to IVF, couples should review what Colorado and other states require insurers to cover and consult our IVF cost breakdown by state. The directory of fertility clinics across Colorado provides context on the broader care landscape, and our guide on how to choose a fertility clinic lays out the key evaluation variables.
A 4.9-Star Rating From 489 Patients
A 4.9-star average across 489 reviews is a meaningful signal. Rating aggregates at that volume are not driven by a handful of vocal enthusiasts — they reflect a sustained pattern across hundreds of distinct patient experiences. Male fertility patients carry a particular kind of emotional load: the stigma attached to infertility in men is real, the diagnoses are often unexpected, and the clinical pathway is frequently confusing. Patients who rate their male fertility provider highly are typically responding to something specific — clear communication, a physician who listened, a process that didn't make them feel like a secondary concern in their own fertility journey.
Posterity's model — rapid access, telehealth-first convenience, and physicians who have dedicated their careers to this subspecialty — is well-designed to generate exactly that response.
Considering At-Home Insemination?
Not every fertility journey begins in a clinic. At-home intracervical insemination (ICI) is a lower-cost, private option that suits patients with no known fertility diagnosis — including single parents by choice, same-sex couples, and people who want to try a few cycles before committing to clinical treatment.
At-home insemination kits like those from MakeAMom come with step-by-step instructions designed for donor or partner sperm. Kits are a one-time purchase that can be reused until conception succeeds, require no clinic visit, and arrive in plain, discreet packaging. Many patients use them as a first step while working toward a fertility consultation — or alongside ovulation tracking while they wait for an appointment slot.
If you have a known fertility diagnosis, have been trying for 12 months without success (six months if you're over 35), or your physician has already recommended IUI or IVF, a board-certified reproductive endocrinologist is the right next step.
Frequently Asked Questions
What does a male fertility evaluation at Posterity Health involve?
A comprehensive male fertility evaluation at Posterity Health begins with a semen analysis, which can be completed via at-home kit without a lab visit. Results are reviewed in a one-on-one consultation with a fellowship-trained reproductive urologist — by video or in person at the Englewood, Colorado office. From there, the physician may recommend additional testing: hormonal bloodwork, sperm DNA fragmentation testing, scrotal ultrasound, or genetic screening depending on what the initial analysis reveals. The goal is not just to flag an abnormal result but to identify the underlying cause and develop a treatment plan. Men with azoospermia, high DNA fragmentation, or suspected varicocele will receive a specific workup pathway rather than a generic recommendation to proceed with IVF.
How does testosterone treatment affect male fertility, and can Posterity manage both?
Exogenous testosterone — including testosterone replacement therapy (TRT) prescribed for low T — can substantially suppress sperm production by disrupting the hormonal signals the body uses to stimulate the testes. Men on TRT who want to conceive should not simply continue their current protocol without specialist guidance. Posterity Health's Hormone Management Program is designed specifically for this clinical context: managing testosterone deficiency using protocols that protect or restore fertility, rather than the standard TRT regimens appropriate for men who do not plan to have children. This distinction is one that many primary care physicians and even general urologists do not navigate precisely. Fellowship-trained reproductive urologists at Posterity are equipped to manage it.
When should a couple involve a male fertility specialist, not just an OB-GYN or REI?
The standard clinical pathway — OB-GYN, then reproductive endocrinologist, with a semen analysis ordered somewhere along the way — is a reasonable starting point but has a structural gap: if the semen analysis is abnormal, the next step is often IVF with ICSI rather than a referral to a reproductive urologist who can investigate the cause. A male fertility specialist should be involved earlier than most couples assume: at the point of the first abnormal semen analysis, before committing to IVF, or when a couple has experienced recurrent pregnancy loss even with apparently normal sperm parameters (sperm DNA fragmentation testing may explain losses that conventional analysis misses). For men with azoospermia, a reproductive urologist is essential — the question of whether sperm can be surgically retrieved for IVF is one that only a trained urologist can answer reliably. Posterity's sub-72-hour appointment availability means that involving a specialist does not need to delay a couple's overall timeline.