Andrology Services at Simply Fertility Introduction Simply Fertility is a licensed Fertility centre within Baddow Hospital, Chelmsford providing full fertility assessment and treatment to the infertile couple. The Andrology laboratory provides diagnostic semen analysis to not only our own patients but to Broomfield Hospital and local GP’s under the Mid Essex Commissioning Group (CCG). Simply Fertility has a dedicated Andrology laboratory providing routine semen analysis, storage facilities and donor sperm banking. This information sheet has been designed to give you as much information as you need when being asked to provide a specimen of sperm for analysis, whether by the Fertility Specialist at Broomfield Hospital or by your own GP. Contents 1. Where are we 2. How do you arrange a semen analysis 3. Where and how to produce your sample 4. Your semen analysis test 5. When will I get my results? 6. Might I need to repeat my test? 7. What if the result is poor? 8. Post Vasectomy Semen Analysis 9. PVSA Appointments 10. Clearance 11. Quality Assurance 12. Notes to the referrer 13. Common Questions Where are we? Simply Fertility Baddow Hospital West Hanningfield Road Great Baddow CM2 8HN Tel: 01245 241 231 Enquiries@simply-fertility.com Document1 Page 1 of 7 Last Reviewed: 18.11.2014 Semen analysis: What is it? Approximately one in six couples have difficulty in conceiving and in approximately 30% of these it appears to be due to a male factor. Sperm problems can range from the complete absence of sperm, to having low numbers or simply poor quality. For this reason it is essential to provide a semen analysis for the diagnosis and possible treatment of any male factor infertility. How do you arrange a semen analysis appointment Appointments have to be made through the GP or fertility specialist. The GP or specialist will provide a referral form and you will then be asked to call Simply Fertility to arrange the appointment. Referral forms and patient information can be found at www.simplyfertility.com As a Semen Analysis patient you can be book an appointment between the hours of 9.30 to 16.00 on Tuesdays and Wednesdays and from 9.30 to 12.30 on Fridays. Appointments can be made on 01245 241 231. Please not the following: 1. All specimens are required to be assessed within 1 hour of production, preferably producing a specimen on site at a pre-arranged time. 2. No specimens will be accepted without prior notice. 3. No analysis will be made without a referral form Where and how do you produce your sample? Simply Fertility provides excellent facilities for the production of a specimen on site, a relaxed and comfortable room where you can provide your specimen through masturbation into a small non toxic sterile container (provided by us). Some will find this embarrassing, for us it is routine and most likely will not ever have to be repeated. If you do have any difficulties in producing your sample then there is no need to worry as we will make arrangements for you to produce it off site, within in your own comfort zone. Semen analysis is critical and time dependent and this is the reason why we prefer that you produce on site. On occasions it will not be appropriate to produce your sample on site and on these occasions we will allow a sample to be produced at home and delivered within 1 hour. No sample will be accepted unless it is produced in a provided sterile sample pot and handed in with the referral form. When producing your sample, remember: 1. Abstain from Intercourse for 2-5 days before producing your sample. There are no benefits for abstaining any longer; in fact it can be detrimental. 2. Ensure that the sample pot provided is properly labelled with the full name and the date of birth. Document1 Page 2 of 7 Last Reviewed: 18.11.2014 3. Before producing sample, wash and dry hands thoroughly with soap provided. There is a WC in this room. 4. Samples should be produced by masturbation; we do not recommend any other techniques in order to avoid any contamination. 5. Please refer to the information sheet on how to operate the TV and films. 6. Do not use lubricant or soap whist producing the sample. Do not use any other sample pot other than the one provided. 7. Provide a complete sample. The first part of the sample contains most of the sperm so if some is lost it will affect the overall test. 8. Produce the sample into the pot provided and place in the envelope, making sure the lid in screwed on correctly. 9. Wash hands then press the bell to alert the embryologist. 10. Open the door and the embryologist will meet you. 11. Hand over the sample. Please inform the embryologist if you did not manage to get the entire sample in the pot. Your semen Analysis Test We examine a number of important sperm factors which all contribute towards the functionality of the sperm. Our Analysis is performed according to WHO (2010) guidelines and the Association of Biomedical Andrologists Guidelines for Good Practice (ABA-GGP, 2012). Sperm concentration - Or sperm count in millions per mL of semen. This is done under the microscope using a specialized counting chamber. Normal range 15 millions per ml or more and a total count of 39 million sperm. Sperm motility - Sperm are graded on their ability to swim. The progressively motile being the most fertile. The normal range is when approximately 30% are progressively motile. Sperm Volume – The volume should be greater than 1.5 milliliters Sperm morphology - The shape and size of the sperm are assessed using a stain. A sample with less than 4% normal forms should be considered as sub fertile. PH level – The PH of the sample should be greater than 7.2 Antisperm Antibodies – This is not routinely provided, unless indicated. Previous vasectomy, sports injury or other trauma to the testes are all indications for assessing the Antisperm Antibodies. When will I get my results? A written report will be sent to the referring doctor within a week, although we generally suggest that patients allow 10-14 days. Your report will use standard terminology for semen analysis with an overall comment. All reports are generated, checked and signed by an HCPC State Registered Clinical Scientist. Urgent results can be faxed to the referring Doctor No results will be given directly to the patient Document1 Page 3 of 7 Last Reviewed: 18.11.2014 Might I need to repeat my test? We sometimes ask for a repeat of your test. This may be because one or more of the factors listed above may be borderline or below what we call the normal range. However, abnormalities with the sample can occur for a number of reasons, e.g. previous illness, stress or medication, so we need a second test to be sure. A repeat sample will usually be organised for 3 months time. Although millions of sperm are produced by the testes every day, for an entirely new batch of sperm to be ejaculated a complete cycle of spermatogenesis (sperm production) needs to occur. This takes around 3 months. By waiting this long between tests we can rule out any temporary disruptions to sperm production which may have been caused for example by a bout of illness or stress. What if the result is poor? Although it is still possible to conceive if the sperm are poor, the chances are usually much lower. However, assisted conception treatments such as in vitro fertilisation (IVF) and intra cytoplasmic sperm injection (ICSI) can be very successful even in cases where there are very few apparently functional sperm. Referrals for treatment can be made by contacting Simply Fertility directly or one of the other providers in the area. Document1 Page 4 of 7 Last Reviewed: 18.11.2014 Post Vasectomy Semen Analysis (PVSA) It is essential that men who have a vasectomy have their sperm tested properly in order that they may be properly informed about when to cease other forms of contraception. Although vasectomy is a very effective and popular contraception, like all others it carries a small but real failure rate. Therefore, failure to attend for PVSA when the surgeon has recommended it could be irresponsible. The requirements for sample production are the same for routine semen analysis. PVSA Appointments Generally, we are required to perform 2 tests but no sooner than 16 weeks post surgery and only when you have ejaculated more than 20 times following your vasectomy procedure. PVSA is usually organised by the surgeon or specialist GP provider who performs the vasectomy. The referring clinician should provide 2 x completed sample request forms and a patient information leaflet. The clinician should clearly state when the vasectomy was performed. You will then book your appointment at least 1 month but no more than 2 months apart to produce 2 semen samples. Clearance cannot be granted without the two analyses. As a PVSA patient you can be book an appointment between the hours of 9.30 to 16.00 on Tuesdays and Wednesdays and from 9.30 to 12.30 on Fridays. Appointments can be made on 01245 241 231. Please not the following: 1. All specimens are required to be assessed within 1 hour of production, preferably producing a specimen on site at a pre-arranged time. 2. No specimens will be accepted without prior notice. 3. No analysis will be made without a referral form Where and how do you produce your sample? Simply Fertility provides excellent facilities for the production of a specimen on site, a relaxed and comfortable room where you can provide your specimen through masturbation into a small non toxic sterile container (provided by us). Some will find this embarrassing, for us it is routine and most likely will not ever have to be repeated. If you do have any difficulties in producing your sample then there is no need to worry as we will make arrangements for you to produce it off site, within in your own comfort zone. Semen analysis is critical and time dependent and this is the reason why we prefer that you produce on site. On occasions it will not be appropriate to produce your sample on site and on these occasions we will allow a sample to be produced at home and delivered within 1 hour. No sample will be accepted unless it is produced in a provided sterile sample pot and handed in with the referral form. Document1 Page 5 of 7 Last Reviewed: 18.11.2014 Clearance Clearance is the term given when a patient can be said to be sterile. The term has been defined in collaboration with local surgeons as follows: 2 sperm free specimens (Azoospermic) At least one with <10,000 immotile sperm and the other one sperm free Special clearance Persistent non motile sperm can exist in men due to either failure to ejaculate regularly or anatomical anomalies leading to retention in the genital tract. For this reason special clearance is given after 28 weeks to patients with persistent non motile sperm retention at a concentration of <10,000 The laboratory only reports its findings and may make recommendations for further testing. However no direct advice is given about continued use of contraception or otherwise by the laboratory unless specifically directed by the surgeon. Quality Assurance Our Andrology laboratory is staffed by HCPC Clinical Scientists (Sate Registered) who work under a quality system that has been qualified and accredited by the Human Fertilisation and Embryology Authority (Centre No 0336) and are highly experienced and well trained in diagnostic semen analysis. The laboratory runs a comprehensive quality control program and is enrolled on the UK National External Quality Assurance Scheme (UKNEQAS). Notes to the referrer Please ensure that your patient has a completed sample request form. The form can be downloaded from the following website. www.simply-fertility.com Please ensure that the patients name, DOB, NHS number and full address are completed. Please ensure we have a full practice details or use a practice stamps. Indicate the type of test you are requesting. Include any other relevant details, including previous semen analysis, history of testicular trauma, genetic disease, previous radio or chemo therapy, chronic illness or ongoing medication. Please also inform us if any patient is known to be an infection risk. Any other queries than please contact either: Andy Glew Sarah Walt Document1 (Laboratory Manager) (Clinical Scientist) 01245 241 231 | andy@simply-fertility.com 01245 241 231 Page 6 of 7 Last Reviewed: 18.11.2014 Common questions What if I am unable to produce a sample? It is not unusual for men to find it difficult to produce a sample to order, and some men may have personal, religious or cultural reasons. Telephone us as soon as possible to let us know and we will discuss the situation with you and rearrange your appointment if necessary. If needed, we can provide a special type of latex-free condom; this device allows you to collect your semen sample during sexual intercourse with your partner. Please note, you cannot use ordinary condoms as they are designed to be toxic to sperm. I only produce a small amount? This is a common concern; remember the average ejaculate volume is about 2.0ml which is less than half a teaspoon. How can I improve my sperm test result? Generally there is no magic remedy to this, but whatever changes you make to improve your lifestyle are unlikely to dramatically change the sperm count or motility but can enhance the health of individual sperms. Lifestyle changes which may improve things include wearing loose fitting underwear, taking showers instead of long hot baths, not smoking and keeping alcohol intake to a minimum. Some men do find that taking vitamin and mineral supplements help but if you have a healthy and varied diet this shouldn't be necessary. Document1 Page 7 of 7 Last Reviewed: 18.11.2014