You have been referred for analysis of your semen quality at Herlev Hospital. 

To deliver a semen sample you have to make an appointment. Read more about booking an appointment on our website:  www.herlevhospital.dk/afdelinger-og-klinikker/Fertilitetsklinikken/Specialfunktioner-i-klinikken/Saedundersoegelse/Sider/

The semen sample should be done from home. So you need to collect a cup for the semen sample before your appointment at the semen laboratory.

You can collect the cup in the reception at the clinic ‘Fertilitetsklinikken’, Herlev Hospital, Monday – Friday 08.00-12.00 and 13.00-15.00. 

To achieve a reliable result of the examination please observe the following:

• Do not deliver a semen sample if you have had fever above 38C within the recent three months.
• Make sure that your previous ejaculation was at least 2 days (48 hours) ago, but no longer than 7 days.
• The semen sample should be produced by masturbation and collected in the cup you have received.
• As a rule we recommend you to produce the sample at home. The semen sample should be received at the Laboratory within one hour of production. Alternatively, the sample can be produced in a separate room in close connection to the Laboratory. It should be kept away from sunlight and at room temperature until delivery at the Laboratory. 
• The sample must not be turned upside down and should be placed as close to your body as possible. 
• Place the sample in a plastic bag together with the questionnaire from the backside of this paper. 

Deliver the sample at Fertilitetsklinikken, Herlev Hospital, (Borgermester Ib Juuls Vej 9), at the time of your appointment. Please take a seat at the male sign and press the button when ready with sample and questionnaire. Please also bring your yellow health insurance card (sundhedskort). 

Your GP will receive the result of the analysis within 7 days after the sample was delivered.

Please fill in the questionnaire, and deliver it together with the semen sample.

Name: _________________________________CPR number: ___________________________

1. Time of ejaculation: Date: ______________ Time: _____________

2. Has any of the ejaculate been spilled? ☐No          ☐Yes 

3. Time of previous ejaculation: Date: ______________ Time: _____________

4. Have you had any illnesses during the last three months? ☐No          ☐Yes

5. Have you had a fever? ☐No          ☐Yes.     
If Yes:
What was the highest temperature? _____ When? ______for how long? _________

6. For patients who have had a vasectomy, please note the date of operation: _____________

7. For patients who have been recanalized, please note the date of operation:_____________

8. Have you previously had a semen analysis at Fertilitetsklinikken, Herlev Hospital? ☐No      ☐Yes. If yes, when? __________________________

9. If yes, was this visit due to previously finding of round cells/leucocyts?______