Introduction
You have been asked to produce a semen sample for fertility investigations. The test will assess the number and quality of sperm present. Many factors can affect sperm quality and you may be asked to produce more than one sample.
IMPORTANT: If you do not follow the instructions in this leaflet your sample may not be processed.
In addition to this leaflet you must have:
• A fully completed test request form with your name, address, date of birth, GP or Clinician details and NHS / Hospital number
• A sample container
• A plastic bag to transport your sample in
An unlabelled or poorly labelled sample will not be tested. Three identifiers are required, including your name, date of birth and the Hospital/NHS number on the container label.
You will need to phone Pathology Reception on 01253 956847 to make an appointment to bring your sample in for assessment. Your name and contact number will be required. Let Reception know if you cannot attend your appointment.
Using a public toilet to produce your sample is against the law.
• You must produce your sample at home and try to get it to reception within 45 minutes of production.
• Abstain from sexual intercourse and masturbation for no less than 2 days and no more than 7 days
• Wash your hands and genitals, and rinse any soap away as this may affect any sperm present
• A condom or artificial lubrication must not be used as these may affect any sperm present
• Ensure that you use only the sample container provided
• Produce your sample by masturbation only and ensure the whole sample is collected
• Ensure the lid is on securely. Write the date and time taken on the container label and place in the plastic bag provided
• Complete all questions on the Sample Details Slip at the back of this leaflet
Excessive heat or cold may affect sperm quality. Keep the sample close to body temperature, for example in trouser pocket.
Deliver the sample to Pathology Reception within 45 minutes of being taken as close to the appointment time as you are able. Do not post your sample or use GP van transport. A receptionist will check sample labelling and that forms are filled in.
Pathology Reception is in Area 2 at the East Park Drive side of the hospital. Use the weblink for a downloadable map and travel information. www.bfwh.nhs.uk/hospitals/blackpool-victoria/map-of-the-hospital
There is a multistorey carpark with a tariff. Alternatively there are short stay/disabled parking bays at drop off point 5 close to Pathology Reception. Enter the building through the East Park Drive entrance. Pathology Reception is on the right (see enclosed map)
Your test results will be issued to your GP or clinician within 7 days. The laboratory cannot issue or discuss your results with you
Appointments 01253 956953
Andrology Lead 01253 953914
Gynae Nurse Practitioner 01253 955517
Hospital Switchboard 01253 300000
Please answer questions 1-8 before bringing your sample.
1 Name: _____________________________________________
Date of Birth: ___/___/___
Address:______________________________________________ _____________________________________________________
2 Date sample was collected ___/___/___
3 Time sample was collected ____________________________
4 Was the whole sample collected? *YES/NO
5 Before today, when did you last ejaculate? ___ days (must be 2-7 days inclusive).
6 I consent that the sample may be used for teaching/quality assurance purposes. *YES/NO (* Delete as appropriate)
7 SIGNED __________________________________________________
If you are not the patient, please write name and relationship to the patient. __________________________________________________
8 Was the sample kept warm during transport? *YES/NO Other sources of information
