Diagnostic semen analysis

Firstly, you need to ensure that your doctor has provided you with a completed semen analysis referral form indicating a request for a diagnostic semen analysis. We recommend that all samples should be produced on site in our private sample production rooms in Ipswich and Cambridge. Where this is not practicable, samples can be produced at home if you live within 30 minutes of either of the laboratories. If you decide to attend our satellite in Peterborough, samples must be produced at home before attending the appointment (no production rooms are available on-site).

We will provide you with a suitable sterile container upon arrival or you can collect your container from Cambridge IVF prior to your appointment if you wish to produce at home. We will only accept samples produced into our own containers, as we know these are fit for purpose and will not compromise the quality of the sample.

Secondly, you need to telephone the Andrology Service on 01223 349010 option 2 and arrange your appointment to produce your sample for analysis.

Please note there may be a wait of up to four weeks before we are able to offer you an appointment, but we will do our utmost to accommodate you as soon as possible.

In order to get the best sample from you, we require you to abstain from any sexual activity (including masturbation) for between 2 days (48 hours) and up to 5 days prior to your appointment date. If you have been unwell and had a raised temperature in the last three months, it is important that you let us know as this can affect the quality of your sperm sample.

In both Cambridge and Ipswich, we have quiet and discrete rooms available for you in which you can produce your sample. In Peterborough, we do not have a production room, this means you will need to produce your sample at home.

Cambridge IVF does not operate a sample ‘drop in service’ as semen analysis is a time critical test and specimens must be produced and analysed at appropriate and pre-arranged times. If you arrive more than 20 minutes after your allocated appointment time or do not have your referral form with you, we will be unable to perform your test and you may have to re-book the appointment. You should therefore give yourself plenty of time to arrive, especially if travelling by car. If you cannot keep your appointment time for any reason please, call and we will re-book your appointment for the next mutually convenient time and date.

Samples are either produced on site (Cambridge and Ipswich) in one of our dedicated sample rooms or at home (Peterborough). At your allocated appointment time a member of our laboratory team will greet you from the waiting area and check your referral form is completed correctly. We will then show you to the private sample room in which you can produce your sample and will provide you with an appropriately labelled sample container (or collect the sample from you if you produced the sample at home). Although our rooms are well proportioned we suggest that you produce your sample on your own; we do not recommend your partner accompanies you into the room, although they are very welcome to wait for you in our waiting area.

• Firstly ensure that you have booked an appointment time
• Ensure that you have been provided with a completed semen analysis request form from your doctor and they have indicated the test required is a diagnostic semen analysis. Your form should have your name, date of birth, NHS number, partners name and partner’s date of birth (if applicable)
• Abstain from any sexual activity for between 2 days (48 hours) and up to 5 days prior to your appointment
• Thoroughly wash, rinse and dry your penis, testicles and hands before you produce the sample
• If producing the sample at home, masturbate and collect the sample into the container making sure you tightly cap it and place it in the self-sealing bag provided. Check that the label on the sample pot has your name, date of birth, NHS number and address. Immediately transport the sample to the laboratory keeping it close to the body, for example in a jacket pocket during transportation
• If producing on site, masturbate and collect the sample into the container making sure you tightly cap it. Check that the label on the sample pot has your name, date of birth, NHS number and address
  • In Cambridge, place it in the hatch to the laboratory (along with your completed referral form and any other relevant document). Close the hatch and press the switch to let the lab team know your sample is ready for collection.
  • In Ipswich, place the sample in the provided sample tray and leave as instructed in the sample room with your completed referral form and any other relevant document. Press the ‘doorbell’ and leave; the lab team will collect your sample from the production room.
• Complete the bottom part of the referral form: we need this information to ensure we get as much accurate information from your semen analysis as possible. If other documents have been provided to you, please make sure these have been completed as well. If any of this information is missing we will not be able to accept the sample so it’s very important that you take the time to check it’s completed correctly.
• Inform us if any of the sample is missed during production. Most of the sperm in the ejaculate are contained in the first part. If you do miss some of the sample we may ask you to repeat the test to ensure an accurate result can be provided to you and to your referring doctor.
• If you are producing at home please bring along photo ID such as a driving license or passport so we can confirm your identity otherwise we cannot accept your sample for analysis.

Our production rooms (in Cambridge and in Ipswich) have been designed to be comfortable and private and a video system is available to you should you wish to use it. In Cambridge, a hatch system links each room directly to the laboratory to allow easy delivery of your sample. In Ipswich a ‘doorbell’ system is in use to inform the lab when your sample is ready. Further site-specific instructions will be given to you by our team before you produce the sample at your chosen location.

Please note that masturbation is the only recommended method for collecting the sample ‘cleanly’ for analysis. The withdrawal method is not recommended as it is likely that some of the sample will be lost and may in any case be contaminated. The first part of the ejaculate contains most of the sperm so this is particularly important. Ordinary condoms cannot be used as these contain a spermicide which will kill any sperm in the ejaculate.

In the instance that for personal reasons you cannot produce a sample via masturbation, please inform a member of staff. In these circumstances, we can provide a kit which includes a non-spermicidal condom. This is a special condom, non-toxic for your sperm, which you can use to produce a sample via sexual intercourse in the comfort of your home. After you have obtained the sample, place the semen from the condom into the provided container making sure you tightly cap it and place it in the self-sealing bag provided. Immediately transport the sample to the laboratory keeping it close to the body for example in a jacket pocket during transportation.

If you have any problems producing your sample or need to change an appointment please give us a call, we will happily arrange another appointment for you.

We look at the important sperm factors which when combined together will give us an indication of your ability to conceive:

• Sperm volume

We record the actual volume in millilitres of the semen sample provided. We do not expect you to fill the container; we would expect an ejaculate to be around 2.5 ml but some patients will produce more or less semen and still have a completely normal semen analysis

• Sperm concentration (sperm count)

Reported as millions of sperm per millilitre of semen. We use a microscope and a special counting chamber to count the number of sperm in the sample

• Sperm motility

Sperm are graded on their ability to swim in a progressive manner. The sperm are grouped into four categories with the strongest swimmers (grade ‘a’) being the most fertile.

• Sperm morphology

The shape and size of the sperm are assessed using our microscope to determine the percentage of sperm in the sample with a ‘normal’ appearance.

• Seminal pH (measure of acidity/alkalinity)

The pH of the sample should be greater than 7.2

• Assessment of non-sperm cells in semen sample

We check for the presence of non-sperm cells such as red and white blood cells in your sample and will report if these are present in numbers which are clinically significant and could indicate further investigations are required.

• Anti-sperm antibodies (if requested)

Anti-sperm antibodies cause sperm to stick together and prevent them from swimming properly. They are seen in approximately 5% of cases and may be indicated by serious testicular sports injuries or vasectomy reversal operations.

• DNA Fragmentation Test (if requested)

Several factors are known to negatively impact sperm DNA integrity (smoke, infections, varicocele, poor diet, cancer…). The result of this test will support clinicians and embryologists when choosing fertility treatments for you and your partner. If you have been asked to have this test performed, please inform us when you telephone to make your appointment.

In addition we may have been asked to perform a sperm preparation test (otherwise known as a ‘test wash’). This involves a washing procedure aimed at harvesting the best quality sperm from your sample for use in assisted conception treatment. This test can only be requested by a fertility specialist as indicated on the referral form. If you have been asked to have this test performed please inform us when you telephone to make your appointment.

After the analysis, your remaining sample will be safely disposed of as Clinical Waste and destroyed following the Trust’s waste management policy. This process complies with the statutory national waste strategies and directives and meets legislative requirements.

If you have given us your written consent, your remaining sample might be used for training purposes or for quality control tests and/or for research and will be safely disposed of immediately after.

A written report will be sent to your referring doctor. We aim to release the final report within 10 working days of the analysis being performed. Occasionally we might experience some delays, in such cases, you will be informed as to when you should expect your results. For reasons of confidentiality we will never give out results over the telephone so please understand the good reasons why any such request will be politely declined.

It is not unusual for us to request a repeat analysis. This will most likely be because more than one of the factors listed above is found to be borderline or below the normal range or it could be because your sample was incomplete. Although this may be shocking news, it is important you realise that abnormalities within your sample can occur for a number of reasons, e.g. previous illness, stress or medication. With this in mind, we use the results of the second analysis to confirm if the findings of the first test were accurate or due to other factors.

If you feel like you need more support, you can book:

· 1:1 Information session: these are held typically on Tuesday evenings over the phone, where you will talk with an embryologist, finance manager and a member of our nursing team. You can discuss all aspects of fertility treatment moving forwards and these sessions are free of charge. You can find more info and can book a slot here.

· Andrology consultation: these are held on select days (typically Thursdays) where you can speak with an Andrologist regarding your results and future possible steps. These appointments are over the phone for 20 minutes and are free of charge. You can call us on 01223 349010 or write to us at cuh.andrology.cambridgeivf@nhs.net to book.

Discovering that you have an undiagnosed fertility issue, will no doubt come as a great shock to you. It is important to realise that this news in the vast majority of cases does not mean you will not be able to father a child. Assisted conception procedures have improved dramatically in recent years and as a specialist fertility treatment centre we are also well placed to offer you both initial support and ongoing assisted conception treatment with your partner following the diagnosis. We work with qualified independent counsellors who are available to you and have experience of working with patients and couples in similar situations. Please contact us on 01223 349010 if you feel you would like an appointment to speak with our counsellor.