Diagnostic semen analysis request

Transcription

1 Fertility Department Diagnostic semen analysis request Information for patients Date of Authorisation: November 2015 Page 1 of 5

2 Infertility is a common problem - at least one in six couples consults their GP because of difficulties in conceiving. Male factor alone is thought to contribute to 30% of these cases, with a combination of male / female factors affecting 40% of couples embarking on assisted conception. Overview Semen analysis is the most important investigation for male sub fertility and the results obtained are a guide for further management. By looking at semen under the microscope, we can determine sperm numbers, sperm quality and function. How to make an appointment The Fertility Department office is open Monday to Thursday from 8.30am to 3pm, and Friday from 9.00am to 12pm (midday). The laboratory operates an appointment only service To book an appointment, please telephone us on (answer phone available) or us at [email protected] Appointments are in great demand so please let us know as soon as possible if you need to change or cancel your appointment. Where should I go on the day of my appointment? Please go to the first Floor of Sherborne Building at Basingstoke and North Hampshire Hospital (please see attached site map). When you reach the first floor, follow the corridor around past the EPAU (Early Pregnancy Unit), Snowdrop Ward and Colposcopy until you reach the Fertility alcove waiting area. What is the process? To ensure results are reliable we recommend you use a pre-weighed non toxic container to collect your sample. If you are planning to produce your sample at home, please collect a container from the Fertility Laboratory beforehand. It is your decision whether you produce a sample at the hospital (we have a private room for you to do this) or at home If you decide to do this at home, you will need to bring the sample to the laboratory as soon as possible for your prearranged appointment (arriving within one hour of production of your sample). Before collection Please do not have sex or masturbate for at least three days (but no longer than seven days) before you produce your sperm sample It is advisable wash/shower or bathe a few hours before collecting your sample Producing your sample The sample must be produced by masturbation (manual stimulation) directly into a wide necked pre-weighed non toxic sterile container collected from the Fertility Department. Do not collect it in a condom, as condoms contain spermicide which kills sperm. It is important that you collect the entire sample, as this will affect the outcome of the results. Ensure the details on your sample container include your full name, date of birth, and NHS number (if available), plus the time and date you produced your sample. Delivery of your sample Keep the sample warm during your journey to the laboratory, ideally next to your skin. Please do not place the sample inside your pocket or a bag, as excessive heat or cold can affect sperm survival. When you arrive, we will check the details on your request form and ask you to complete some paperwork to assist in the assessment of your sample. Date of Authorisation: November 2015 Page 2 of 5

3 Acceptance and rejection of samples We can only accept your sample if all the details have been completed on your request form. Your sample also needs to be labelled with your full name, date of birth, NHS number (if available) and date and time of sample. Please do not deliver your sample at any time other than your booked appointment, as we will not be able to accept it. We will reject your sample if you have collected it in an unsuitable container. To ensure results are reliable we recommend that samples are collected in pre-weighed non toxic containers available from the Fertility Laboratory. How do I get my results? If you are a fertility clinic patient, your result will be reviewed and linked to your fertility notes. We will discuss the results with you at your next clinic appointment. After this appointment the outcome of all the investigations will be forwarded by letter to your GP. We may ask you to repeat your sample or have blood tests that will help with your fertility management. If your GP has referred you, we will send your test results to your surgery within a few days. We recommend that you contact your surgery - to discuss the results seven days after your test. Please note If you are a GP patient the laboratory is unable to give you results or to discuss your results with you. Why might you ask me to repeat the test? When your results are ready, the laboratory may ask for you to repeat your test. You should discuss reasons for this with the doctor who referred you for the test. Results can be affected if: You have not complied with the abstinence period (see Before collection) Your sample was incomplete, due to spillage or incomplete collection Your results may also be affected by surgery, previous infection, recent illness or high temperature, prescribed or recreational drugs. Sperm take approximately three months to develop, so in most cases there is little value in performing a repeat test earlier, unless requested by the laboratory. Once a report has been issued your sample is disposed of in line with Hospital Trust guidelines (unless you have consented to your sample being used for internal quality control purposes) Quality of results The Fertility laboratory staff are highly qualified in diagnostic semen analysis. The department employs an internal quality scheme and has been a member of the NEQAS Andrology external Quality Control programme since 1999 and laboratory CPA accredited since In 2014 we became a UKAS accredited medical laboratory No. 8082, which means we are accredited to provide this service in accordance with ISO 15189:2012 As a department we are committed to delivering a quality service and welcome any comments on the provision of this service. Date of Authorisation: November 2015 Page 3 of 5

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5 Laboratory number NHS number: Surname: Forename: Date of Birth Address Basingstoke and North Hampshire Hospital Fertility Department DIAGNOSTIC SEMEN ANALYSIS REQUEST FORM Requesting GP/ Consultant: NHS: Private Patient : Location: (Surgery / Department) Copy to : Address: Date of sample Production : Time: Days since the last Ejaculation: Lab use only: On Site Y/ N Received by lab: Tested by lab: Did you collect the entire sample into the container? Female Partner Name : Please complete the following Medical History: Date of Birth: Have you had a recent illness or high temperature? Do you have an infectious disease? Do you suffer from diabetes? Surgical History? have you experienced any of the following: Undescended testes, removal of testes Hernia repair Testicular torsion or surgery Any other surgery : Medication / Drug information- Prescribed: Recreational Drugs: Yes/ No Anabolic steroids: Social History: Do you? Smoke How many per day= Alcohol Yes/ No Units per day = (e.g. 1pt beer /cider=2/3units large wine=3units) While you are working are you exposed to any of the following: Ionising radiation,chronic heat exposure, Aniline dyes, Pesticides, lead exposure, or other ; If yes please say which Please sign to confirm that all the details are correct on this form and your sample: Tick the box to consent to your sample being used for quality control purposes Date of Authorisation: November 2015 Page 5 of 5