Specimen Collection/delivery Quality of Our Service information slip The Andrology department is a CPA accredited Please complete the following information, cut laboratory. The laboratory participates in external along the perforation and bring to the quality assurance (UKNEQAS) and internal quality department with your sample. assurance is monitored. All tests carried out are in accordance with ABA guidelines and WHO (World analysis Date sample delivered to laboratory…………..* Health Organisation) guidelines (2010). Date of operation……………….….* All specimens will be tested by State Registered Number of days since last ejaculation/ sexual Biomedical Scientists who are regularly competency Patient information assessed. After testing, your specimen may be used intercourse………………* for quality checks, audit purposes or teaching. leaflet Should you have any concerns regarding the service Time specimen was produced: …………….…* or any aspect of your care please speak to the Senior Biomedical Scientist, or if you prefer, the Patient Was the entire specimen collected into the Advice Liaison Service (PALS) container i.e. no spillage?………………………*

Any medication and or illnesses……………… Questions and Queries

…………………………………………………… If you have questions regarding your sample please ring the laboratory on 01254 732959 or Name of person of delivering specimen to find us on: www.pathologyineastlancs.co.uk department………………………………

* Compulsory information needed, failure to complete will result in No Smoking Policy specimen rejection The NHS has a responsibility for the nation’s Please choose an option below and tick the health. Protect yourself, patients, visitors and box: staff by adhering to our no smoking policy. Smoking is not permitted within any of our I consent to my sample being used for training or hospital buildings or grounds. news.discovery.com Quality control purposes

I DO NOT consent to my sample being used for train- 1 hour post vasectomy ing or Quality control purposes Translation service

Please check you bring with you: This document can be produced in Braille, on audio cassette and in other languages upon Labelled specimen request, please call 01254 734380. Request form Department of Andrology Completed collection/delivery slip Clinical Laboratory Medicine Laboratory use only:

Date specimen arrived in laboratory: Time specimen arrived in laboratory: Specimen accepted by:

CP/AF188 Post vasectomy patient information Rev 4 June 2017 Introduction Instructions for collecting the semen Delivery of your sample After your vasectomy operation you may resume sample RBH having intercourse as soon as you feel able. The Andrology Laboratory is based in the A one hour post vasectomy semen analysis will be In order that an optimum specimen is obtained Department of Clinical Medicine, Level 0, Royal required approximately 12 weeks post operation there should be a period without sexual Blackburn Hospital, Haslingden Road, Blackburn with a minimum of at least 20 ejaculations. activity/ejaculation of at least 2-7 days before the This involves producing a semen sample into a specimen is produced, but no more than 7 days, as BGH specimen container and delivering it to the sperm can start to degenerate after this time. The Gynae 3 (Uro Gynae) Womens and Children, Level 1, Area 5, Burnley General Hospital, Casterton laboratory within 1 hour of production. This is Avenue, Burnley. carried out by APPOINTMENT ONLY . The specimen should be collected at home

and not in a public place as it is illegal. The semen will be analysed for any moving sperm, (We are NOT open Saturday, Sunday or bank as any still present in your semen can result in holidays on either site). . Use contraception until the doctor who Specimen must be collected by only performed your vasectomy operation informs you (lubricants must not be used) and passed directly Photographic instructions are enclosed with your that your post vasectomy semen sample is clear. (without loss) into the sterile container provided appointment Your referring doctor will be notified with the results ( or other containers must not be within 7 days of receipt of the specimen. used). Ensure that the container is properly Results sealed. The specimen should be collected no These instructions are based on the British more than 1 hour before delivery to the If you have been referred by your GP, your results Andrology Society, Association of Biomedical laboratory. will be sent to them within 7 calendar days from Andrologists and the British Association of receipt. Please contact your doctor’s surgery to

Urological Surgeons Guidelines 2016. arrange this appointment. *Any samples over 1 hour old will not be If you have been referred by a hospital doctor, they The sample will be analysed according to the processed through the laboratory and a will write to you with an appointment where they will World Health Organisation (WHO) standards for repeat sample will be asked for.* discuss your results. volume, presence of semen and motility. The specimen pot must be clearly labelled with Results are not available from the laboratory. your full name, DOB, time of collection and Arranging a Semen analysis for 1 Hour number of days since last sexual activity; if any of Repeat testing Post Vasectomy this information is missing the report may be delayed. If you are required to perform a repeat test due to Your G.P or Clinician will send an electronic the specimen being rejected (guidelines not request to our department for an appointment to be After the sample is collected it must be transferred to followed). made for you. If the appointed time is not the laboratory in the blue bag as close to body If you have positive motile sperm– it is important to convenient please telephone 01254 734380 to temperature as possible, within 1 hour of produce your second sample on the same number re-arrange the appointment. production. Any delay could affect the nature of the of abstinence days to ensure consistency and specimen. accuracy in results. They will also give you a blue pack that will contain a pre-weighed specimen pot and guidelines. When transporting the specimen- place the Your referring clinician should ask the Andrology Please do not use any other container other container close to your body to keep warm Department for a repeat test and we will send you than the one supplied in your pack as some an appointment,. and take it directly to the Andrology plastics are toxic to sperm. Replacement pots can If the appointed time is not convenient please Department. be collected from your GP surgery or Andrology telephone 01254 734380 to re-arrange the department at RBH. appointment.