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GP Area - Male Fertility Lab

Diagnostic semen analysis

The Hull Andrology Unit has close associations with the Hull IVF Unit and therefore we feel that by offering the andrology service we are able to offer continuity of care for patients who may need further treatment. We are a team of qualified Clinical Embryologists who are fully trained in semen analysis and have applied knowledge of interpreting test results. By providing this service we can offer advice and support to GPs and Consultants on the clinical significance of findings. Immediate advice and action can be available for patients that may require further specialist follow up and to avoid possible later invasive surgical retrieval methods.

How to refer a patient for a semen evaluation

  • Each patient will need a Hull Andrology referral card, a semen specimen container and bag.
  • The cards can be downloaded and printed out when needed. To order the cards, specimen pots and bags please call 01482 674715.
  • The card needs to be fully completed. The card must include the male patient's full name, date of birth and NHS number. You must also provide your own name, practice stamp and signature.
  • Please provide us with clinical information/the type of test required. By providing clinical information, such as if the patient has had a previous analysis, this allows us to provide useful interpretive comments and further advice.
  • Instructions on how to produce the sample and where/when to bring it are on the reverse of the cards.
  • Please re-iterate to the patients that samples are only accepted at the Hull Andrology Unit on Monday, Wednesday or Friday from 8.30 -14:00 (excluding bank holidays).
  • Andrology staff reserve the right not to accept samples with incomplete request cards. It is essential that correct identification of the patient and GP can be made for confidentiality reasons.
  • There is a specific acceptance and rejection criteria, please see the user guide for more information. 

DOWNLOAD CARDS HERE FORM1-_Semen_Analysis_with_map_20_01_15.doc 

Results

  • Results will be reported via labcentre/patientcentre. Some GPs will also receive paper copies (if this service has been previously arranged).
  • Results should be reported on the system within 5 working days. Please let us know if you are continually experiencing problems retrieving results.
  • Occasionally results can not be reported. This may be because the GPs name is not on the card, the card is not signed, the patient’s details are not fully completed or the referring doctor is not on the lab centre system.
  • If you have any problems obtaining results please call the unit during opening times.
  • Occasionally the sample is unsuitable for analysis. You will be informed of this via labcentre/patientcentre. Common reasons for not processing samples include; the sample leaking, the sample arriving outside of opening hours or the sample arriving over 60 minutes from the time of production.

Repeat tests

  • We will sometimes suggest a repeat analysis may be advisable. This will be the case if the correct instructions were not followed for the production and delivery of the sample.
  • We may also suggest a repeat if the parameters are significantly reduced, or if there is a complete absence of sperm in the ejaculate. Semen evaluations can vary or co-founding variables could affect the results.
  • Patients who have not followed abstinence advice or have not collected the complete sample will also be advised to repeat if the results fall outside "normal" parameters.
  • Once a very poor result has been confirmed these patients may then benefit from referral to an urologist, to the subfertility clinic or may wish to make a private appointment with a fertility specialist to investigate and discuss this further.

Interpretation of results

All evaluations are carried out in accordance to WHO (World Health Organisation) guidelines. Prior to 2012 the WHO (1999) reference limits were used. From January 2012 onwards, the WHO (2010) reference limits and guidelines will be adhered to. Standard operating procedures have been reviewed and updated in line with the WHO (2010) guidelines considered relevant to the tests we perform. This will ensure we are working in accordance with best practice guidelines and offering the highest level of treatment to our users and patients.

All equipment in the laboratory is regularly serviced, calibrated and maintained. Motility assessments are carried out at 37oC. Operational errors are minimised by training and internal/external quality control schemes. Sometimes errors in analysis could be caused by improper production of the sample, failure to keep the sample at body temperature, not collecting the whole sample or the sample not being examined within one hour of production etc. Repeat analyses are therefore advisable for unexpected results or those of a significantly reduced quality.

Individual parameters may not always provide the best insight into fertility. The “overall” sample should be looked at as a whole. For example if a patient has slightly reduced motility, but a very good sperm count and volume, this could be enough to overcome lowered motility. A slightly reduced sperm count may not be significant if motility is sufficiently high enough to overcome this short fall. Below are some of the “normal” parameters characterised by the WHO (2010):

ParameterNormal LimitComment
Volume ≥ 1.5 ml Low volume could indicate: incomplete sample, partial retrograde, obstruction or androgen deficiency.
Sperm Concentration ≥ 15 x 106 M/ml A very low sperm count may indicate a partial/full blockage or testicular failure. May recommend a referral to fertility specialist or urologist for investigation.
Total sperm count (per ejaculate) ≥ 39 x 106 (Concentration x volume). This is not directly reported in the report but will be commented on if significant.
Total motility (progressive + non progressive) ≥ 40% Motility is temperature dependent and samples which take over an hour to reach the lab will be recommended a repeat.
Progressive motility ≥ 32%  
Morphology ≥ 4% "Strict" criteria.
Cell count ≥ 3 m/ml Culture and sensitivity may be advisable if cell number exceeds this.
MAR test (anti-sperm antibody test) ≥ 50% IgG &IgA Caused by trauma to testicles/prior surgery. Common in vasectomy reversals. Causes agglutination of spermatozoa.
Sperm Vitality  ≥58 % Non-routine test performed only on samples with low motility

Every measurement will be subject to a margin of doubt. The level of doubt surrounding the true value can be described by the ‘uncertainty of measurement’. When comparing a patient's result with the biological reference limits, the Consultant should be made aware of the uncertainty of measurement (see user guide).

WHO Guidelines are continuously reviewed and updated – New parameters will be updated when published data is available.

These parameters should be considered as a “whole sample” and alongside female investigations.

Recent periods of illness, stress or prescribed/un-prescribed drugs (including steroids/chemotoxic/radiotherapy) can all affect the quality of a semen sample. Complete production and ejaculation of spermatozoa takes approximately 70-90 days. Therefore repeat semen analyses, 3 months after exposure to these variables could be beneficial.

Please call the Andrology Unit on 01482 388948 if you require assistance with the interpretation of results.

Further referral

Patients who may qualify for NHS funding can be referred to the subfertility clinic at Hull Royal Infirmary. Those patients who may not qualify for funding or wish to be seen as private patients can be referred to the Hull IVF Unit. We are able to refer patients who may need further investigations to an Urologist if advisable.

FORM1-_Semen_Analysis_with_map_20_01_15.doc

Post-vasectomy semen analysis

A team of fully trained embryologists carry out Post Vasectomy semen evaluations to confirm the presence or absence of sperm. All samples are analysed in accordance to standards set by the British Andrology Society (BAS), to promote best practice. Guidelines state that if no sperm are seen by direct microscopy, the centrifugate should also be examined for the presence or absence of spermatozoa. The BAS also recommends that initial assessment should be undertaken 12 weeks post vasectomy and after the patient has produced at least 20 ejaculates. Patients should be advised to continue contraception until two consecutive, sperm free samples have been reported. These should be 2 to 4 weeks apart.

How to refer a patient for a post-vasectomy semen analysis

  • Patients should be supplied with two fully completed referral cards, two semen specimen containers and bags.
  • These cards can be downloaded and printed directly from the link at the end of this document.
  • To order cards, specimen pots and bags please call 01482 674715.
  • The cards must be fully completed. This should include the patient’s details (name, dob, NHS number). Your own name, practice stamp and signature, along with the type of test required.
  • It is recommended that patients should undergo abstinence for no less than 2 days and no more than 7 days. The BAS also recommend that the time from production to examination of the sample should be no longer than 4 hours.
  • Patients bringing the sample in for analysis should drop the sample at the Hull Andrology Unit on a Monday, Wednesday or Friday between 8.30 and 14:00. Samples will not be accepted by the unit outside of these hours.
  • Samples will also be accepted from the GP run, but will not be analysed within the four hour recommended time limit. It is therefore preferable for patients to bring samples directly to the laboratory within the recommended time limit.
  • Andrology staff reserve the right not to accept samples with incomplete request cards. It is essential that correct identification of the patient and GP can be made for confidentiality reasons.
  • There is a specific acceptance and rejection criteria, please see the user guide for more information. 

Results

  • Results will be reported via labcentre/patientcentre within 5 working days. Some GPs/ consultants will also receive paper copies. Please let us know if you are continually experiencing problems retrieving results.
  • Occasionally results can not be reported. This may be because the GPs name is not on the card, the card is not signed, the patient’s details are not fully completed or the referring doctor is not on the labcentre system.
  • If you have any problems obtaining results please call the unit during opening hours.

Interpretation of results

The following results may be reported:

  • No spermatozoa seen. The seminal fluid and a centrifugate has been examined by direct microscopy and no spermatozoa were seen over several fields.
  • Very occasional spermatozoa seen. Less than 5 spermatozoa seen when examining either the neat seminal fluid or centrifugate.
  • Occasional spermatozoa seen. Less than or equal to 50 spermatozoa seen when examining either the neat seminal fluid or centrifugate.
  • Occasionally a sperm count (M/ml) may also be entered if there is sufficient quantity of spermatozoa.
  • It is recommended by the BAS that two consecutive sperm free ejaculates should be reported before the confirmation of sterility following vasectomy can be achieved. These samples should be two to four weeks apart. This may occasionally take several samples.
  • If persistent sperm are found in a patient’s samples, it is essential that the patient bring further samples directly to the andrology laboratory within one hour of production. This is to ensure we can exclude the presence of potentially fertilising motile sperm.

 FORM1-_Semen_Analysis_with_map_20_01_15.doc