Fertility & Reproductive Medicine Laboratory
University College Hospital
Elizabeth
Garrett Anderson Wing
Semen Analysis Referral Form
Lower Ground Floor
Please return to contact details and an appointment will be issued.
London, NW1 2BU
Alternatively, provide patient with form and an appointment can be
General
enquiries:
020 3447 9436
booked using details below. Must be accomanied by an
Fax: 020 3447 9143
'undertaking to pay’ form if private patient.
Email: fertilitylab@uclh.nhs.uk
PATIENT
DETAILS
NHS
PRIVATE
NHS No:
UCLH Hospital No:
Surname
Date of Birth
Forename(s)
Full Address:
Post Code:
Telephone number(s)
REFERRING
PRACTITIONER
Consultant:
Email Address
GP:
Other (please state):
Name of Consultant:
Name:
Clinic/Surgery:
Address:
Post Code:
Telephone Number:
Fax Number:
REGISTERED GP (IF DIFFERENT FROM REFERRING PRACTITIONER)
Name:
Clinic/Surgery:
Address:
Postcode:
Telephone Number:
Fax Number:
REASON FOR REFERRAL / INVESTIGATIONS REQUIRED / ADDITIONAL INFORMATION
E.g. any disability or special requirements
REFERRER SIGNATURE:
DATE:
PATIENT INFORMATION: SEMEN ANALYSIS
Appointments for semen analysis are between 1.30pm and 4pm on Mondays,
Tuesdays, Wednesdays and Fridays. The appointments last approximately thirty
minutes.
Please call the phone number at the bottom of this page to make an appointment. If
you are already registered as a patient at this hospital please have your hospital number
to hand. If you are not registered as a patient please bear in mind that we will need to
register you over the phone. Note that there is high demand for appointments for semen
analysis – please ensure that you are on time for your appointment. You must bring
your semen analysis referral form to your appointment. At the time of your
appointment please ensure you have abstained from sexual intercourse/ejaculation
for between three and five days.
Once here we will endeavour to see you as quickly as possible. You will not have a
consultation during this appointment. We will supply you with a sterile specimen pot and
ask you to write your name and date of birth on the pot. You will also be asked to
complete a production form. When there is a private production room available for you
we will show you to the room and advise you where to deliver your sample for analysis.
In order for your sample to be representative we ask that the sample is produced by
masturbation, and you may wish to bring your own appropriate illustrated material to the
appointment. Please do not use lubricants/spermicidal condoms/withdrawal method to
produce your sample as these can interfere with the results, making your analysis
inaccurate. Once you have delivered your sample to the laboratory you are free to leave;
the results will be returned to your referring doctor.
If you have difficulty producing a sample at the clinic it is possible to produce a sample
off site and bring it in to us. If you intend to produce a sample off site you must make
prior arrangements with us. In addition the sample must be kept at body temperature
and delivered to the clinic within an hour of production accompanied by a signed
production form.
Directions / Transport
Address:
Fertility & Reproductive Medicine Laboratory
Elizabeth Garrett Anderson Wing
Lower Ground Floor (Entrance on Grafton Way)
University College Hospital
235 Euston Road
London
NW1 2BU
Public Transport Links
Bus No's 10, 73, 24, 29, 134, 18, 30, 88
Tube: Warren Street (Northern/Victoria Lines) or Euston
Square (Circle/Hammersmith & City/Metropolitan Lines)
Results
The results of your semen analysis will be returned to your referring doctor. If your
referrer is based at UCH, they will have the results available to them at your next
appointment. If your referrer is at another hospital or a GP surgery, please allow ten
days for the results to reach the doctor before you contact them to discuss. Please do
not contact the laboratory regarding the results as staff will not be able to give you any
results either in person or via the telephone.
UNDERSTANDING YOUR SEMEN ANALYSIS RESULTS
A semen analysis is an assessment of various aspects of a man’s sperm and semen.
The aim is to identify any factors that may be influencing your fertility, and you doctor
may request this for a number of reasons, for example:




To investigate difficulties conceiving
To determine fertility treatment suitability
To confirm success of a procedure e.g. vasectomy / vasectomy reversal
To assess effects of other procedures on fertility e.g. post-chemotherapy or surgery
Semen samples from the same man can vary greatly, and your doctor may request
repeats tests in order to confirm the results.
The World Health Organisation has published ‘reference values’ for each of the
parameters examined during a semen analysis. The values are based on the results
seen in men who have achieved a pregnancy within 12 months of ceasing
contraception. Values outside of these ranges do not necessarily mean that you are
infertile, but can indicate potential difficulties in achieving a pregnancy.
The table below is taken from the World Health Organisation publication (2010). The
figures in bold are used as the ‘reference values’ for what might be considered
‘normal’. In fact, the different semen parameters need to be considered in relation to
each other and there are no strict cut-offs for what is ‘normal’ or ‘fertile’. Your doctor
can help you to understand your results.
Centile
Semen Parameter
2.5
5
10
25
50
75
90
95
Semen Volume (ml)
Sperm Concentration
(millions / ml)
Total Sperm Number
(millions / ejaculate)
Total Motility (%)
Progressive Motility
(%)
Sperm with Normal
Morphology (%)
Antisperm
Antibodies
1.2
9
1.5
15
2.0
22
2.7
41
3.7
73
4.8
116
6.0
169
6.8
213
97.
5
7.6
259
23
39
69
142
255
422
647
802
928
34
28
40
32
45
39
53
47
61
55
69
62
75
69
78
72
81
75
3
4
5.5
9
15
24.5
36
44
48
Consensus value: >50% binding in MAR test could indicate
immunological impact on fertility
(Table taken from WHO Manual for the Examination and Processing of Human Semen 5 th ed. 2010; Source:
Cooper et al., 2010)