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Clinical Specialist Services Care Group
CountyDurham Assisted Conception Unit

Instructions for the production of a Semen Sample

for Investigation in the County Durham ACU

In order to obtain the best semen sample, please read all instructionsBEFORE planning to produce your sample.

  1. All semen tests are to be produced in the gentlemen’s room within the County Durham ACU, Ground Floor, Bishop Auckland Hospital. Condoms should not be used to collect semen samples, as the spermicide can interfere with the viability of the spermatozoa. The withdrawal method (coitus interruptus) also invalidates the analysis. We understand that for some men, physiological, religious and/or cultural beliefs prevent sample collection by masturbation. If you feel that this could be a problem for you, please contact the ACU for further advice.
  1. Sample should be collected after a period of 2 – 7 days of sexual abstinence. Please record abstinence on attached form.
  1. Contamination of the semen during production must be avoided. First pass urine, then thoroughly wash, rinse and dry your penis and hands. The entire sample should be produced by masturbation directly into the specimen container.

Please record any loss of sample on attached from.

  1. Label the container clearly with your full name, date of birth, date and time of production. Please complete the attached question sheet and return with your sample.
  1. Inform us of any illness or attach a list of any medication you may be currently taking.
  1. Samples will be accepted by appointment only.

To arrange an appointment or change an existing appointment, please telephone the ACU on

01388 455849 or 01388 455845.

From time to time it is necessary to carry out internal quality control, audit or research in the laboratory. To be able to carry this out we need fresh semen samples to analyse. We would like your permission for us to use any semen remaining from today’s sample. Be reassured this will not affect the investigations carried out on your sample today.

I …………………………………………… give / do not give permission for the County Durham ACU laboratory to use any remaining semen from my sample produced today, for the purposes of research, audit or internal quality control.

Signature ………………………………

Date……………………………...

SEMEN ANALYSIS PATIENT QUESTIONS

Please provide the following information: (all patients)

Your full name:………………………......

Your date of birth:………………………………………………………………………………………

Your address:………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

Your telephone number:……………………………………………………………………………………….

Please answer the following questions: (all patients)

  1. Date sample produced:…………………………………….
  2. Time sample produced: …………………………………….
  3. How many days is it since you last ejaculated?…………………………………….
  4. Is this the entire sample?…………………………………….

Post vasectomy patients only:

  1. Date of vasectomy operation:……………………………………
  2. Number of samples previously submitted:…………………………………...

Fertility patients only:

  1. Partners name:……………………………………
  2. Partners date of birth:…………………………………..

PLEASE BRING THIS FORM WITH YOU WHEN YOU BRING THE SAMPLE AND HAND IT IN WITH THE SAMPLE.

LF/BA/FC/60v6Page 1 of 1Expires 13/06/2018