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CENTER FOR REPRODUCTIVE MEDICINE & FERTILITY The University of Chicago Medical Center 333 S. Deplanes Street, Suite 201, Chicago, IL 60661 Phone (773) 7026642; Fax (773) 7025848 SEMEN ANALYSIS LABORATORY

How to fill out semen analysis laboratory requisition

How to fill out semen analysis laboratory requisition:

1. Obtain the requisition form: The first step is to obtain the semen analysis laboratory requisition form. This form can usually be obtained from the healthcare provider or the laboratory conducting the analysis.
2. Fill in personal information: The form will typically require the individual's personal information such as their full name, date of birth, and contact information. Ensure that this information is filled out accurately and legibly.
3. Provide relevant medical history: The requisition form may include a section where the patient needs to provide relevant medical history. This could include information about any past or current medical conditions, medications, surgeries, or treatments that may impact the semen analysis results. It is important to provide accurate and detailed information to ensure the analysis is conducted in the appropriate context.
4. Indicate reason for analysis: The form may ask for the reason for the semen analysis. This could be for general fertility assessment, infertility evaluation, or post-vasectomy confirmation, among others. Select the appropriate option that aligns with the purpose of the analysis.
5. Specify any additional tests: Depending on the specific requirements of the healthcare provider or the laboratory, there may be additional tests requested along with the semen analysis. These could include tests for sexually transmitted infections or genetic disorders. Indicate any additional tests that are to be conducted.
6. Provide insurance information: If applicable, the form may ask for insurance information. This is important for billing purposes. Fill in the necessary insurance details accurately.
7. Sign and date the form: Before submitting the requisition form, make sure to sign and date it. This affirms that the information provided is true and accurate to the best of your knowledge.

Who needs semen analysis laboratory requisition?

1. Couples experiencing fertility issues: Semen analysis is often performed as part of the evaluation for couples who are struggling to conceive. Both partners may need to undergo various tests, including a semen analysis, to identify any potential issues that may be affecting fertility.
2. Individuals planning vasectomy: Prior to undergoing a vasectomy, healthcare providers typically require individuals to have a semen analysis to confirm the absence of sperm in their ejaculate. This is an important step in the process of vasectomy.
3. Individuals seeking fertility preservation: People who are considering fertility preservation, such as sperm banking, may need to undergo a semen analysis to assess the quality and quantity of their sperm before storage.
4. Those monitoring reproductive health: Semen analysis may also be recommended for individuals who are concerned about their reproductive health or want to assess their fertility potential. This could include individuals who have had previous medical conditions or treatments that may impact their reproductive function.

Note: The specific requirements for obtaining a semen analysis laboratory requisition may vary depending on the healthcare provider and the laboratory conducting the analysis. It is always recommended to consult with a healthcare professional to understand the specific process and requirements for obtaining a requisition form.

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