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1. Hsc Bagi Aai ang Regional Fertility Centre M HealtHmaRk VJ Social Care Trust gel REGIONAL ANDROLOGY SERVICE USER MANUAL SOLELY FOR FERTILITY CLINICIANS AND PATIENTS POST VASECTOMY SAMPLES ARE NOT ACCEPTED DOCUMENT HISTORY Original Author D LUTTON Date of Original Document 10 10 11 Electronic Location GOVERNANCE ISO MANAGEMENTSYSTEM PATIENTINFORMATION ANDROLOGY ACTIVE Please ensure that this is the most up to date version of the Regional Andrology Service User Manual Document Identification MA AN UserManual Doc No 773 Version 08 Date Created 10 10 11 Date Reviewed 16 06 15 Revised Yes No Yes Reviewer Anne Havern Authorised by Dr Deborah Lutton Page 1 of 7 Belfast Health and egional Fertilit entre Social Care Trust o aai Introduction The Regional Andrology Service RAS is located on the first floor of Royal Maternity Hospital It forms part of the Regional Fertility Centre RFC which is within the Belfast Health amp Social Care Trust The RAS gained Clinical Pathology Accreditation CPA in September 2013 The Andrology Laboratory has its own separate entrance which can be found to the left of the main stairwell on the first floor of the hospital Directions Come into Royal Maternity Hospital through the Main Hospital Walk past reception and turn left Continue until the lifts and stairs are reached on the left Take eithe2. The semen analysis test A comprehensive semen analysis is carried out on samples examining a number of factors which all contribute towards a man s ability to conceive Sperm concentration This is measured in millions of sperm per milliliter of semen This is done using a microscope and a special counting chamber Sperm motility Sperm are graded on their ability to swim The fast forward swimming sperm are generally the most fertile Sperm morphology The proportion of sperm in the sample that have a normal appearance is assessed Antisperm antibodies These are found in some patients and can reduce sperm motility and cause the sperm to stick together They are common in men who have had vasectomy reversal operations Trial wash Where appropriate a trial wash is performed in which the sample is prepared and washed as it would be on the day of treatment This helps the senior embryologist decide on the most suitable type of fertility treatment should this prove necessary Laboratory Service The laboratory is open from 8 00 am to 4 30 pm Monday to Friday Request forms Andrology request forms may be obtained from the Administrative Staff at the Regional Fertility Centre by telephoning 02890 635888 and choosing option 4 Requests will only be accepted from registered medical practitioners patients cannot self refer It is essential that request forms are fully completed Health and Care H amp C numbers must be provided Inco
3. Within the Regional Andrology Service the following steps are taken to minimise uncertainty e Semen analysis methodologies are based on WHO fifth edition recommendations e There is robust confirmation of the patient s identity and details on the specimen container s request and report forms are matched e Strict specimen acceptance criteria are applied with only complete samples accepted in appropriate specimen containers e The period of abstinence is defined 2 7 days e tis requested that all men produce on site to control the variation in sample collection and transportation e The interval between collection and analysis is defined and semen analysis is commenced within an appropriate timeframe e There is traceability and toxicity testing of materials in significant contact with sperm All laboratory equipment is appropriate and regularly serviced and maintained Samples are well mixed prior to analysis Measurement of motility is carried out at 37 C Sampling error is minimised by assessing large numbers of sperm wherever possible Staff are trained and their competency is assessed at intervals e Robust Internal and External Quality Control measures are in place Document Identification MA AN UserManual Doc No 773 Version 08 Date Created 10 10 11 Date Reviewed 16 06 15 Revised Yes No Yes Reviewer Anne Havern Authorised by Dr Deborah Lutton Page 6 of 7 Belfast Health and o egional Fe
4. therefore it is important that the following are adhered to Patients should e Abstain from ejaculation for 2 3 days before their appointment but not more than 7 e Empty their bladder before producing the semen sample e Produce the sample by masturbation only e Attempt to collect ALL of the sample into the container provided and advise a member of the Andrology staff if any of the sample is not collected e Use only the container provided by the Regional Andrology Service to collect their sample e Ensure that the container is clearly labelled with their name address and date of birth e Tell the laboratory staff if they have been ill or had a viral infection eg flu in the last three months or if they have been on medication Patients should NOT e Use a condom to collect the sample as condoms can adversely affect sperm e Use lubricants when producing the semen sample as lubricants can have a detrimental effect on sperm e Expose the sample to extremes of temperature If transporting the semen sample to the laboratory it should be carried inside their jacket or trouser pocket to keep it close to body temperature e Use containers other than those provided by the Andrology laboratory as they cannot be accepted and a new appointment will need to be booked If patients are unable to produce a semen sample by masturbation then a special condom a Male Factor Pack is available by prior arrangement with the Andrology Labora
5. er Document Identification MA AN UserManual Doc No 773 Version 08 Date Created 10 10 11 Date Reviewed 16 06 15 Revised Yes No Yes Reviewer Anne Havern Authorised by Dr Deborah Lutton Page 5 of 7 Belfast Health and egional Fertilit entre Social Care Trust KA oiai Turnaround Time The turnaround time from receipt of referral to posting out of Semen Analysis report is 40 working days Patients who have been referred by outside centres will have their results issued to their referring doctor This will be approximately 2 weeks after their semen analysis The turnaround times are closely monitored Patients who have been referred for a semen analysis by a Regional Fertility Centre doctor will receive their semen analysis results at their next review Our aim is to provide the highest quality of service with prompt delivery of accurate results backed up by specialist medical and scientific expertise Comments on how the service could be improved are always welcomed Uncertainty in Diagnostic Semen Analysis Uncertainty in relation to laboratory testing simply means the existence of doubt or a level of error associated with a particular measurement A degree of biological uncertainty exists when only a single semen sample is tested Procedural uncertainty also exists from errors associated with specimen collection to sample testing method bias sampling error and operator error through to final reporting
6. mplete forms will be returned to the referrer Full clinical and identifying information is essential to ensure the highest quality service Once the completed request form is received by the RFC administration staff an appointment will be booked for the patient and a letter given or sent to the patient Specific directions regarding the production of the sample will be included in the letter to the patient Sample production and what a patient needs to know in preparation for the test Semen samples should be produced in the discreet facilities available within the Andrology suite This is because samples must be maintained at body temperature Document Identification MA AN UserManual Doc No 773 Version 08 Date Created 10 10 11 Date Reviewed 16 06 15 Revised Yes No Yes Reviewer Anne Havern Authorised by Dr Deborah Lutton Page 3 of 7 Belfast Health and egional Fertilit entre Social Care Trust i Sa and analysed within one hour of production A member of Andrology staff will guide patients to this facility Adult literature is provided within this facility for those who wish to avail of it In exceptional circumstances only samples may be produced off site but only by prior arrangement with the Andrology or Embryology staff In this situation instructions will be provided individually to the patient together with an appropriate container A number of factors can affect the performance of the test and
7. nition those of 5 of the fertile men who provided data used in the calculation of the reference range A man s semen characteristics need to be interpreted in conjunction with clinical information The Regional Andrology Service is CPA accredited ISO 9001 2008 certified and takes part in an external quality assurance scheme UKNEQAS Document Identification MA AN UserManual Doc No 773 Version 08 Date Created 10 10 11 Date Reviewed 16 06 15 Revised Yes No Yes Reviewer Anne Havern Authorised by Dr Deborah Lutton Page 7 of 7
8. r the lift or stairs to the 1st floor On exiting on the 1st floor turn left The Andrology Laboratory entrance will be found 25 meters along the corridor on the right hand side The full postal address is Regional Andrology Service Regional Fertility Centre Royal Jubilee Maternity Service Grosvenor Road Belfast Health amp Social Care Trust Grosvenor Road Belfast BT12 6BA Telephone RAS 028 90633986 RFC 028 90635888 Clinical Service The bulk of the clinical referrals to the RAS are in the areas of Gynecology and Fertility with the occasional referral from General Practitioners Fertility Clinics are held within the Regional Fertility Centre on the ground floor of Royal Maternity Hospital at the Grove Well Being Centre and at other Trust s throughout the Provence Gynaecology Clinics are held at throughout the Provence RAS Staff Medical Director Dr Peter McFaul Scientific Director Laboratory Director Dr Deborah Lutton Andrologists Dr Joan McKinney Ms Anne Havern Miss Emma McLean Laboratory Technician Ms Carly Huddleston Document Identification MA AN UserManual Doc No 773 Version 08 Date Created 10 10 11 Date Reviewed 16 06 15 Revised Yes No Yes Reviewer Anne Havern Authorised by Dr Deborah Lutton Page 2 of 7 Belfast Health and egional Fertilit entre Social Care Trust is CNOSSEN Sn The above staff may be contacted by telephoning the Regional Fertility Centre on 028 9063 5888
9. rtilit entre Social Care Trust i Tr e A verification of report step is in place to ensure that the transcription from any hand written laboratory form is free from error e Results are checked and authorised by senior staff Lower reference limits 5th centiles and their 95 confidence intervals for semen characteristics For professional use only Parameter Lower reference limit Semen volume ml 1 gt 1 4 1 7 Total sperm number 10 per ejaculate 33 46 9 Sperm concentration 10 per ml 5 12 16 Total motility progressive non 40 38 42 progressive Progressive motility PR 2 31 34 Vitality live spermatozoa Si 55 63 Sperm morphology normal forms 4 3 0 4 0 pH 27 2 MAR test motile spermatozoa with bound beads Di Adapted from WHO Manual 5th Edition The reference distributions shown provide a description of the semen characteristics of recent fathers whose partner became pregnant within 12 months of stopping use of contraception Semen characteristics are highly variable both within and among men and are not the sole determinants of a couple s fertility the ranges therefore provide only a guide to a man s fertility status Men whose semen characteristics fall below the lower limits given here are not necessarily infertile their semen characteristics are below the reference range for recent fathers as are by defi
10. sues of confidentiality and data protection Please avoid telephoning wherever possible Non urgent telephone calls create a significant workload and cause unnecessary delay in processing samples Interpretative comments and reference ranges are incorporated into the results reports The department is happy to assist in the interpretation of test results if required For advice and interpretation please contact a Senior Embryologist on either 028 90633986 or 028 90632237 Repeat tests Sometimes it is necessary to repeat a test This may be because e part of the sample was lost by the patient at the time of production e one or more of the parameters examined was borderline or below the normal range the patient did not abstain from sexual activity before the test the patient had abstained for too long in advance of the test the patient had been ill in advance of the test the patient was unable to ejaculate on the day of the test other reasons A repeat test is then necessary to help staff to make an accurate decision on the most suitable type of fertility treatment should this prove necessary The repeat test will either be arranged directly by the Andrologist or a letter will be sent to the referrer stating that a re referral is required Directions will be provided on how soon the repeat test should be performed Following an illness the advice may be to wait for a defined period of time to allow for semen production to fully recov
11. tory What if need to change my appointment If you are unable to attend the appointment you have been given then please contact the Regional Fertility Centre via Tel 02890635888 option 4 or Fax 02890 634435 to arrange a convenient date Please bear in mind that the laboratory is a regional centre and deals with many samples each day so if you Document Identification MA AN UserManual Doc No 773 Version 08 Date Created 10 10 11 Date Reviewed 16 06 15 Revised Yes No Yes Reviewer Anne Havern Authorised by Dr Deborah Lutton Page 4 of 7 Belfast Health and egional Fertilit entre Social Care Trust KA need to change your appointment then an alternative may not be available before 3 6 weeks Car parking There are visitor s car parks providing on site parking for a small charge Please note that the car park can often be extremely busy and patients should leave additional time for parking If the patient is more than 30 minutes late for their appointment it will need to be rebooked Results Semen analysis results form will be posted to the referring doctor or the named individual e g Secretary and address that is detailed on the referral form Patients who are attending the RFC will receive their semen analysis result at their next review appointment with their RFC doctor Unfortunately the Andrology and Embryology staff are unable to provide results over the phone or by e mail or fax due to is
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