Referral
Criteria
If a patient has been having regular unprotected sex for at least 12 months and their partner has not conceived, we recommend arranging a referral for a diagnostic semen analysis.
The andrology laboratory operates by appointment only. Appointments can be booked via the NHS e-Referral Service. They are available Monday to Friday. You will also need to complete our referral form.
Once we have received the referral, we will confirm an appointment in writing. We may also contact patients by phone or text as part of our reminder service.
Please let the patient know that prior to their appointment, they need to abstain from ejaculation for 48 hours – 7 days.
We have produced a patient information leaflet that you will need to give patients before their appointment.
Funding
Not all patients are eligible for treatment funded by the NHS. The GP Commissioning Group decides this. We can advise on a patient’s eligibility for NHS funding.
We provide a fee-paying service for those who are not eligible. The current prices are available on our private patients website.
Receipt of samples
We do not provide a ‘drop-off’ service. This is to ensure that samples can be handled appropriately prior to processing. Also, this control helps manage the time from ejaculation to analysis more effectively according to WHO guidelines. Patients are required to produce their sample on site at the appropriate appointment time
Concerns over producing a semen sample
If a patient is worried about being able to produce the sample, please encourage them to attend their appointment. If at the appointment, the patient finds they cannot produce a sample, the andrology staff will arrange an appointment time for them to bring their sample from home.
The sample needs to reach the department within 40 minutes of production and be as close to their appointment time as possible. Samples delivered after 40 minutes may still be analysed but may require a repeat if parameters are outside the normal range.
Tests performed
- Liquefaction/Viscosity assessment
- pH
- If low volume or low sperm count.
- Volume
- Sperm concentration (reported in millions/ml)
- Sperm motility
- Sperm morphology
- Round cells
- Presence of high numbers may require a repeat test for infection screening.
- Presence of aggregation or agglutination
- We do not perform anti-sperm antibody testing as this is no longer recommended by NICE guidelines due to insufficient evidence of their significance.
- Vitality testing
- Will be done only if deemed necessary on samples with no motile sperm.
We do not perform post vasectomy semen analysis. This can be carried out by cytology at the RVI.
Viral positive samples
You must book viral positive samples (HIV, Hep B/C etc.) directly with our diagnostic laboratory, as these require special processing appointments.
Results
We examine several factors to determine the quality of the semen sample, as recommended by the 2021 WHO criteria.
This criterion is based on data on semen quality of a reference population of men, whose partners had a time to pregnancy of 12 months or less.
Under these parameters, we consider the lower 5th percentile as a biological reference limit for further investigation. The table below outlines the details on each parameter.
Report
Interpretative comments
| Parameter | Biological decision limits WHO 2021 guidance – lower 5th centile | Comments and interpretation |
|---|---|---|
| Volume | ≥ 1.4 ml | Low volume could be due to partial sample loss (loss of a fraction of the ejaculate during sample collection), partial retrograde, obstruction or androgen deficiency. |
| Sperm Concentration | ≥ 16 x 106 M/ml | Sperm concentration is related to fertilisation and pregnancy rates. It can be affected by abstinence and sample loss (first part of the ejaculate is considered sperm rich). A very low sperm count may indicate a partial/full blockage or testicular failure. Note that low counts <0.5M/ml will have an increased sampling error (>5%), associated with the result, due to insufficient numbers counted. |
| Progressive Motility | ≥ 30% | The extent of progressive sperm is related to pregnancy rates. Sperm progression is temperature dependent and samples that take over 40 mins to reach the lab will be recommended to repeat if motility is low. |
| Morphology | ≥ 4% | This is related to how the sperm look and is a strict analysis. The low threshold and variability can make it difficult to interpret as a stand-alone parameter in a diagnostic analysis. Severe morphological defects may require referral as they may lower fertilising potential. |
If any of these parameters are outside the lower 5th percentile, this may indicate male factor infertility. We may recommend either collecting a repeat sample or referring the patient to the fertility centre.
This lower 5th percentile represents the level under which less than 5% of the reference population were found.
Semen analysis results should be used in conjunction with their medical history and partner’s fertility investigations.
Repeating a semen analysis
Several factors can influence semen analysis results, which may result in a repeated analysis. These may include:
- length of abstinence
- initial portion of the ejaculate not collected
- illness
- medication
This is a common occurrence and is often requested to confirm the results of the initial sample.
We recommended waiting 3 months after the initial analysis before arranging a repeat test. This is because of the cycle of spermatogenesis (making sperm) which takes around 64 days.
Rejection criteria
- Samples that arrive without appointments – These samples will be rejected and the patient will be informed of the correct way to book an appointment and advised to go back to their GP.
- Patients arriving more than 10 minutes late for their appointment will be required to book another appointment. This is due to the workload in the lab and ensuring samples are analysed in a timely manner.
- Post vasectomy samples – we cannot provide clearance for post vasectomy samples. Please refer patients to clinical cytology at the RVI.
Turnaround time
We provide results electronically. For GPs, they can be accessed by ICE. If you cannot access ICE, we can make alternative arrangements for the results. We aim to turn around samples within 2 weeks of semen analysis.
Measurement of uncertainty
Every measurement will have a level of uncertainty. For example, if a patient was to return to provide a similar sample, there would be variation in the results.
As long as the two results fall within the “measurement of uncertainty” (depicted at U), the two results are not significantly different with a level of confidence of approximately 95%. This means that a sperm concentration result of 14M/ml and 16M/ml falls within the 95% confidence interval and is not considered significantly different.
When considering the biological reference limits, these uncertainties are considered during reporting (often referred to as borderline values).
| Measurement | Measurement of uncertainty (U) |
|---|---|
| Volume | ± 0.013 ml |
| Concentration | ± 14.6% |
| Morphology | ± 2.1 % |
| Progressive Motility | ± 8.1 % |
