<p>ST. PETER’S HOSPITAL LABORATORY St. Peter’s Hospital</p><p>Instructions for collection and delivery of specimen for Semen Analysis</p><p>SPECIMENS ACCEPTED MONDAY through FRIDAY 8 a.m. to 1 p.m. No holidays. APPOINTMENTS ARE REQUIRED. Please call to schedule or with any questions: 525-1486.</p><p>1. The sample should be collected at home after a 2-3 day period of sexual abstinence. </p><p>2. Collect specimen by masturbation into a sterile plastic container. If your physician did not provide a container to you, one can be requested from St Peters Hospital Laboratory 525-1486 when calling for your appointment. </p><p>3. Standard condoms even when thoroughly washed and rinsed, hold spermicidal agents and must NOT be used. </p><p>4. Label the container with your name and time of collection. Keep specimen as close to body temperature as possible until delivery is made to the laboratory. Good ways to transport are in pant or shirt pockets or under the arm. Extreme heat or cold will harm this specimen.</p><p>5. Specimen should be delivered ASAP after collection to the Hospital Outpatient Laboratory. Specimens may NOT be dropped off at auxiliary sites.</p><p>6. Let them know you are a patient delivering a time dependent specimen. The technical staff will need to know the collect time and verify the specimen is labeled. Maximum elapsed time interval for delivery to lab should be no more than one (1) hour for patients being evaluated for infertility.</p><p>7. St Peter’s Hospital participates with most insurance companies. Prior to collection you may wish to call your insurance company to verify participation and coverage for this test. </p><p>Patient Name: </p><p>Date of Collection: Time of Collection: </p><p>Days of abstinence prior to collection: Complete specimen in cup? </p><p>Collection method: Masturbation Condom Other </p><p>Was specimen kept close to body during transport? </p><p>History of vasectomy? If yes, date of procedure: </p><p>Rev 4/7/2011 N:\Hem Manual\Semen Collection</p><p>Semen Specimen Collection and Delivery 12/12</p>