Introduction
You have been asked to produce a semen sample for testing to check if your vasectomy procedure has been successful. The semen is examined to see if it is clear of sperm. More than one sample may be required for this.
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 completed test request form with your name, address, date of birth
• GP or clinician details and hospital/NHS number
• a sample container
• a plastic bag to transport your sample in
Please follow your GP or clinicians’ instructions when producing your sample for analysis.
• Ensure that the timing of your sample is correct. This this is the number of weeks after your vasectomy.
• Produce the minimum number of ejaculations before producing your first sample for analysis; this is usually 20.
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. Please let reception know if you cannot attend your appointment.
Check you have a completed request form. It may be a barcoded form or alternative request form. If you do not have a request form then contact your GP or clinician and ask them to issue you with one.
An unlabelled or poorly labelled sample will not be tested. Three identifiers are required including your name, date of birth and Hospital/NHS number on the container label.
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 or 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 the questions on the Sample Details Slip at the back of this leaflet.
Excessive heat or cold may affect sperm. Keep 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 the sample labelling and that all the forms have been completed.
Pathology Reception is in Area 2 on the East Park Drive side of the hospital. The following web link has a downloadable map and travel information: www.bfwh.nhs.uk/hospitals/blackpool-victoria/map-of-the-hospital
There is a multistorey car park with a tariff. Alternatively, there are short stay/disabled 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 956847
• Andrology Lead 01253 953914
• Whitegate Drive Sexual Health 0300 1234154
• Spire Fylde Coast Hospital 01253 394188
• Urology Reception 01253 956943
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
