Reproductive Medicine Laboratory, Edinburgh Fertility Centre

Semen Analysis
Laboratory Form
Patient name Referring GP/Clinician
Address Referring Medical
Practice / Hospital Ward

DOB / CHI
(Attach addressograph, if available) (Attach GP label, if available)

Patient to complete before handing sample to a member of staff

Date of sample: Have you ever tested positive for:

Time of sample:  HIV  None listed
Abstinence period (days): days  Hepatitis B
Was the whole sample collected?  Yes  No  Hepatitis C

If you do not consent to any remaining sample to be used for training or quality control,
please write “NO” in the box?

I confirm, as the patient named above, this is my semen sample. Signed:

For Post-Vasectomy Samples Only

Date of vasectomy: Number of weeks since surgery (minimum 12 weeks):
Has the sample been produced after at least 20 ejaculations?  Yes  No

Laboratory staff to complete

Production: Home Onsite Pot batch: Date/time rec’d (initials):

Analysis delay Normal morphology (%) Mic / Initials

Initials
( / )
Volume (ml) TZI
( )
Appearance
6
Liquefaction Round cells (x10 /ml)
Viscosity
pH PVSA / Query Azoo Motile (Y/N)
LVFDS Count Mic / Initials
Motility Replicates Mean
Mic / Initials
( / )
A / Theoretical conc (sperm/ml)
( / )
B /
A+B Comments
C /
D /
Total motility (A+B+C)

Counts 1/2 /
Mic / Initials
Dil/Sqrs / ( / ) Date analysis complete ( )
Factor Date of Apex entry ( )
6 Chamber
Conc (x10 /ml) Date checked/authorised ( )
6 ( )
Total count (x10 )
6 Attach lab number(s) here
Total motile (x10 )

Doc. ID: EFR-F-79 v14 Author: L. Wales

Issue Date: 04.09.2024 Authority for Issue: D. Collins Page 1 of 2
 Patient Information

Appointments: To book your appointment, please phone the Andrology office on 0131 242 2463 at least 2
working days after being referred by your GP or clinician. You’ll be asked for the numbers that are written on
the lid of the specimen pot you were given so please have this information ready before you phone. If you
don’t call to book your appointment within 12 weeks, your referral will be removed from the list and re-referral
will be needed. Office opening times are Monday to Thursday 8am to 4pm and Friday 8am to 3:30pm.
Please note that we may not be open on public holidays.

Sexual abstinence: To optimise your sample, you should not ejaculate (either through masturbation or
sexual intercourse) for at least 48 hours before your appointment and no more than 7 days should have
gone by since the last ejaculation. If an additional sample is required, this should ideally be repeated 3
months after the initial test (unless otherwise advised) and the number of days abstinence should be
consistent.

Producing your sample: We need to receive your sample within 50 minutes of production (45 minutes for a
post-vasectomy test). If you live less than 50 minutes from the hospital (or 45 minutes for post-vasectomy),
we ask that you produce your sample at home. If you are unable to arrive within that time, you’ll need to use
a private room at our centre. Please do not produce your sample in any public space, including public toilets
– under UK law, this is classed as an obscene act in a public place, contrary to the Sexual Offences Act
2003.

Before producing your sample, pass urine and wash hands and genital area with soap and water. Rinse the
soap and water away and dry with a fresh towel (soap and water can damage sperm). Don’t touch the inside
of the specimen pot as it’s sterile. Produce your sample by masturbation, ensuring your sample goes directly
into the pot. If the entire sample isn’t collected, this may produce inaccurate results. Don’t use a condom or
collect your sample after intercourse as this can be harmful to the sperm and affect results. Replace the lid
on the pot, ensuring a good seal to avoid spillage. Make sure your name and date of birth is on the pot and
put it in the sealable part of the specimen bag. Complete the questions overleaf and place the form in the
outer pocket of the bag.

If producing at home, when transporting the sample, keep the pot upright to avoid leakage and keep the
sample as close to body temperature as possible (e.g. inside jacket pocket). If producing your sample onsite,
a member of the lab team will show you to one of the private rooms. If you’re unable to produce a sample by
masturbation, please contact us and we can advise further.

Arriving at the centre: The Reproductive Medicine Laboratory is part of the Edinburgh Fertility Centre
based at the Royal Infirmary of Edinburgh (Little France). We are part of the Simpson Centre for
Reproductive Health and located on the Ground Floor. We are closest to Car Park 1G. When you arrive at
the centre, a member of the andrology team will check your pot and form to make sure we have all the
information needed for analysis. We ask that you arrive at your appointment time as the samples are time
sensitive and we have patient appointments throughout the day. If you’re more than 10 minutes late, we will
likely need to reschedule your appointment. If you think you might be late for your appointment or need to
cancel your appointment, please contact us on 0131 242 2463 as soon as possible.

Post-vasectomy semen analysis: It’s recommended that your post-vasectomy semen analysis is carried
out after a minimum of 12 weeks from your surgery and after a minimum of 20 ejaculations.

Retrograde semen analysis: If your clinician or GP thinks you may have retrograde ejaculation, you’ll be
given 2 specimen pots. Before producing your semen sample, please urinate to empty your bladder. Next,
follow the information in “Producing your sample” and collect any semen produced by masturbation into one
pot. In the other pot, collect the post-ejaculation urine sample (volume of urine should be reasonably low).

Samples unsuitable for analysis: We are unable to analyse samples that are too old, have leaked or have
been exposed to extreme temperatures, and we are unable to accept samples if you don’t have an
appointment.

Results: Results can take up to 2 weeks and can only be sent to the GP surgery you’re registered with or to
the consultant who referred you. Results can’t be given by the laboratory team.

Consent: By providing a sample for semen analysis at our laboratory, your consent to the analysis of the
specimen is inferred. On occasions, we may require samples for training of new members of the team or for
quality control purposes. This will have no impact on your analysis or results and only residual semen will be
used after preparation of the sample for your semen analysis. You may opt out of this if indicated
on the section for “Patient to complete”.

Doc. ID: EFR-F-79 v14 Author: L. Wales

Issue Date: 04.09.2024 Authority for Issue: D. Collins Page 2 of 2