Semen Analysis

Overview

The NHS recommends that semen analysis should be considered if a couple have had regular sex without using contraception for over 1 year (or 6 months if female partner is 36 or over) and have not been able to get pregnant (1).

In BNSSG, semen analysis is available as a separate and routine pathology test and is not subject to restrictions. However, it is advised that requests for semen analysis outside of the above recommendations should be avoided. 

Recommendations to improve the chance of conception and improve sperm quality include (1):

• Couples should try to have intercourse every 2 to 3 days without using contraception.
• Reduce alcohol consumption if above recommended limits (14 units per week).
• Lose weight if overweight
• Stop smoking
• Wear Loose fitting underwear - tight underwear can increase the temperature of your testicles which may affect the quality of sperm
• Avoid exposure to chemicals at work such as pesticides, solvents or some heavy metals.

Semen Analysis for BNSSG patients

NHS semen analysis is currently available at 5 licensed centres locally - four in Bristol and one in Bath. 

Patients requiring basic semen analysis, which remains a general pathology test, can be provided by the NHS providers listed below.

• CARE Fertility Bath, Peasedown St John, Bath

• CARE Fertility Bristol, Aztec West, Bristol (Please note this is a satellite site of Bath CARE Fertility). 

• Bristol Centre for Reproductive Medicine (BCRM), Bristol

• CREATE, Bristol

• London Women’s Clinic , Cardiff & Bristol

Referral

A generic BNSSG Semen Analysis Request Form (available on EMIS) should be sent by email to the provider of choice. The form includes a list of local licensed providers and their email addresses (also listed below).

Please check which clinic the patients wishes to attend at the time of referral. The completed form should then be forwarded accordingly.

On receipt of referral, clinics will provide pots, information leaflets and appointment times direct to the patient (samples can't be dropped off without an appointment).

Once an appointment has been made samples can be produced on site or dropped off at the clinics and results will be posted to the referring GP/Consultant the following working day.

The email addresses of providers are as follows:

• bristol@londonwomensclinic.com (secure email account) or by post to London Women’s Clinic Bristol, Nuffield Health Bristol Hospital, The Chesterfield, 3 Clifton Hill, Bristol, BS8 1BN [Directions to New Location]
• ruh-tr.enquiries-bfc@nhs.net for Bath or Bristol, or by post to CARE Fertility Bath, Roman Way, Bath Business Park, Peasedown St John, Bath BA2 8SG. Please state in referral if Bristol is preferred.
• lab@bcrm.clinic (secure email account) or by post to Bristol Centre for Reproductive Medicine, 135 Aztec West, Almondsbury, Bristol BS32 4UB
• create.fertility@nhs.net or by post to CREATE Fertility Bristol, Litfield House, 1 Litfield Place, Bristol, BS8 3LS

Interpreting Results - under review

Low or Abnormal Sperm Count

The WHO have set parameters for 'normal' ranges of semen quality (including volume, concentration, motility, progressive motility, morphology) (2)

These semen parameters are only guidelines to consider when investigating what could be causing infertility. Having better or worse numbers than the WHO guidelines does not necessarily mean that patients will or won't be able to conceive with their own sperm (3).

If not within the normal range then a repeat semen analysis may be advised - normally with a minimum of 3 months between samples. The lifestyle advice in the overview section above should be recommended.

Azoospermia or severe oligospermia

The total absence of sperm or severe oligospermia (defined as low sperm count <1million per ml taken on two occasions 3 months apart) in a sample may be an indication for a referral to NHS fertility services outside the normal 2 year timeframe as long as other criteria are met.

See the Infertility page for further advice.

Treatment of abnormal sperm count

NHS treatment of abnormal sperm count is only available through the infertility pathway if criteria are met. Please therefore do not refer directly to other NHS services.

Post vasectomy semen analysis

Please note that the services listed above are for Semen analysis for fertility purposes and not for post vasectomy semen checks.

Please see the Vasectomy page for further information

Resources

(1) Low sperm count - NHS (www.nhs.uk)

(2) WHO laboratory manual for the examination and processing of human semen

(3) Semen Analysis: How It's Done and Understanding Results (parents.com)

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.