Reception: Request a semen analysis

Please complete this form if you have been requested by your GP to get your semen tested. This may of been via your partners consultation or your own. A semen analysis is where a sample of semen (sperm and associated fluid) is analysed to check the quality and quantity of the sperm. The results are usually available within a week.

If the results are not normal, the test should be repeated to ensure it was accurate. This will normally be performed after approximately 3 months.

Your GP can refer you to a specialist in male infertility at your local hospital or fertility clinic if any problems are found.

Semen analysis is done in at University Hospital Coventry & Warwickshire (UHCW). 

What is the process?

Step 1: Complete this form

Step 2: Our GPs will confirm your request and send the form to you electronically via text

Step 3: Print the form out and follow the instructions in the text message to arrange your appointment

Please note if you do not have access to a printer then select this option below and you can collect the form from reception. You will be texted once it is ready for collection.  

Please do not write any clinical queries on this form. Any clinical queries or request for appointments via this form will be discarded. To make an appointment either book online via the NHS app/Patient access or by calling reception. We will start to process your form by the next working day but it will take up to 3 working days to complete. Please DO NOT call before 3 working days as you will not receive a status update from reception or the administrative team. If you are NOT a registered patient then your form will be discarded. This service is only for patients registered at the surgery aged 16 and over.
Reception: Request a semen analysis
Most couples who are trying for a baby and having regular sex without any contraception don’t need to seek medical advice until they have been trying for one - two years.
Smoking is a well known factor to reduce sperm quantity and quality. For help on quitting smoking please see the link above the form.
Alcohol consumption is associated with increased numbers of morphologically (structurally) abnormal sperm
Please state in Kg (Kilos) or Stone & lbs. Increased weight has been shown to cause marked reductions in fertility. If you are eager for further advice on this please click on the fitter futures link above.
If you do not have access to a printer we will print the form for you and let you know once it is ready for collection via text.

Important: If you notice a lump, pain or enlargement of your testicle it is vital you call us to arrange an appointment with the GP.


Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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