Information for GPs
Diagnostic semen analysis:
The Hull Andrology Unit has close associations with the Hull IVF Unit and therefore we feel that by offering the andrology service we are able to offer continuity of care for patients who may need further treatment. We are a team of qualified Clinical Embryologists who are fully trained in semen analysis and have applied knowledge of interpreting test results.
By providing this service we can offer advice and support to GPs and Consultant on the clinical significance of findings. Immediate advice and action can be available for patients that may require further specialist follow up and to avoid possible later invasive surgical retrieval methods.
Download the request cards here: FORM – Semen analysis form 20 11 17
Interpretation of Results:
All evaluations are carried out in accordance to WHO (World Health Organisation) guidelines. Prior to 2012 the WHO (1999) reference limits were used. From January 2012 onwards, the WHO (2010) reference limits and guidelines will be adhered to. Standard operating procedures have been reviewed and updated in line with the WHO (2010) guidelines considered relevant to the tests we perform. This will ensure we are working in accordance with best practice guidelines and offering the highest level of treatment to our users and patients.
All equipment in the laboratory is regularly serviced, calibrated and maintained. Motility assessments are carried out at 37oC. Operational errors are minimised by training and internal/external quality control schemes. Sometimes errors in analysis could be caused by improper production of the sample, failure to keep the sample at body temperature, not collecting the whole sample or the sample not being examined within one hour of production etc. Repeat analyses are therefore advisable for unexpected results or those of a significantly reduced quality.
Individual parameters may not always provide the best insight into fertility. The “overall” sample should be looked at as a whole. For example if a patient has slightly reduced motility, but a very good sperm count and volume, this could be enough to overcome lowered motility. A slightly reduced sperm count may not be significant if motility is sufficiently high enough to overcome this short fall. Below are some of the parameters characterised by the WHO (2010):
|Parameter||Lower Reference Limit||Comment|
|Volume||≥ 1.5 ml||Low volume could indicate: incomplete sample, partial retrograde, obstruction or androgen deficiency.|
|Sperm Concentration||≥ 15 x 106 M/ml||A very low sperm count may indicate a partial/full blockage or testicular failure. May recommend a referral to fertility specialist or urologist for investigation.|
|Total sperm count (per ejaculate)||≥ 39 x 106||(Concentration x volume). This is not directly reported in the report but will be commented on if significant.|
|Total motility (progressive + non progressive)||≥ 40%||Motility is temperature dependent and samples which take over an hour to reach the lab will be recommended a repeat.|
|Progressive motility||≥ 32%|
|Morphology||≥ 4%||“Strict” criteria.|
|Sperm Vitality||≥58 %||Non-routine test performed only on samples with low motility|
|MAR test (anti-sperm antibody test)||< 50% IgG &IgA||Caused by trauma to testicles/prior surgery. Common in vasectomy reversals. Causes agglutination of spermatozoa.|
Every measurement will be subject to a margin of doubt. The level of doubt surrounding the true value can be described by the ‘uncertainty of measurement’. When comparing a patient’s result with the biological reference limits, the Consultant should be made aware of the uncertainty of measurement (please see andrology user guide).
WHO Guidelines are continuously reviewed and updated – New parameters will be updated when published data is available.
These parameters should be considered as a “whole sample” and alongside female investigations.
Recent periods of illness, stress or prescribed/un-prescribed drugs (including steroids/chemotoxic/radiotherapy) can all affect the quality of a semen sample. Complete production and ejaculation of spermatozoa takes approximately 70-90 days. Therefore repeat semen analyses, 3 months after exposure to these variables could be beneficial.
Please call the Andrology Unit on 01482 388948 if you require assistance with the interpretation of results.
Patients who may qualify for NHS funding can be referred to the subfertility clinic at Hull Royal Infirmary. Those patients who may not qualify for funding or wish to be seen as private patients can be referred to the Hull IVF Unit. We are able to refer patients who may need further investigations to an Urologist if advisable. Getting Started
Post-vasectomy semen analysis:
A team of fully trained embryologists carry out Post Vasectomy semen evaluations to confirm the presence or absence of sperm. All samples are analysed in accordance to standards set by the British Andrology Society (BAS), to promote best practice. Guidelines state that if no sperm are seen by direct microscopy, the centrifugate should also be examined for the presence or absence of spermatozoa. The BAS also recommends that initial assessment should be undertaken 12 weeks post vasectomy and after the patient has produced at least 20 ejaculates. Patients should be advised to continue contraception until the consultant is satisfied with the results.
Page Last Modified: 10th January 2020