Collection of Semen for Analysis

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Collection of Semen for Analysis Specimens will be accepted Monday through Friday between 6 a.m. and 7 p.m. excluding holidays. Private collection rooms are not available at either of the testing sites. 1. Semen is to be collected after a period of two to seven days of sexual abstinence. 2. Produce the specimen by masturbation and collect in a sterile plastic container. Note: Collection by interrupted sexual intercourse (coitus interruptus) is not recommended due to a likely loss of the first portion of the ejaculate, which contains the highest concentration of spermatozoa. Condoms contain spermicidal agents and must not be used for specimen collection. 3. Label the container with patient’s name, date of birth and date and time of collection. It is very important that testing begins within 30 minutes after collection. 4. The specimen should be kept as close to body temperature as possible. Protect from extremes of heat or cold until it reaches the laboratory. 5. Please complete the questionnaire on reverse side and bring it with you to laboratory. 6. The specimen must be taken directly to the laboratory at either Lakeland Hospital, Niles or Lakeland Medical Center, St. Joseph within 30 minutes after collection. Lakeland Hospital, Niles Lakeland Medical Center 31 N. St. Joseph Avenue 1234 Napier Avenue Niles, MI 49120 St. Joseph, MI 49085 NS050-127 (6/17) www.lakelandhealth.org Lakeland Laboratory Semen Collection Patient Information Form Patient Name: __________________________________ Date:__________________ This information is required for adequate interpretation of your test resultes. Date of collection: __________________________________ Time of colletion: ___________________________________ q a.m. q p.m. Days of abstinence prior to collection ________________________ days. Method of collection q Masturbation (Preferred) q Coitus Interruptus Was any portion of ejaculation not collected? q Yes q No Was specimen protected from extreme heat or cold? q Yes q No Is this a post vasectomy specimen? q Yes q No Specimens will be accepted Monday through Friday between 6 a.m. and 7 p.m. excluding holidays..

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A History of Birth Control Methods
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