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Text File  |  1993-01-27  |  2KB  |  40 lines
  1. $Title{Comprehensive Semen Analysis Report}
  2.  
  3.  
  4. Patient:                                Spouse:
  5. Date of Specimen:                       Time Specimen Produced:
  6. Time Analysis Begun:                    Method of Collection:
  7. Days Since Last Ejaculation:            Any Portion of Specimen Lost?
  8. Present Medications:
  9.  
  10. ------------------------------------------------------------------------------
  11. Parameter                            Results        Normal Values
  12. ------------------------------------------------------------------------------
  13. Color                                               Gray/Translucent
  14. Coagulate?                                          Yes
  15. Liquify?                                            Yes
  16. If Yes, Time in Minutes                             <= 30
  17. Volume (ml)                                         2-6
  18. Viscosity (1, 2, 3, 4)                              1
  19. pH                                                  7.5-8.1
  20. % motility                                          >= 50%
  21. % of 3-4+ Forward Motile Sperm                      >= 50%
  22. Sperm Concentration
  23. (X 1 Million per ml)                                20-200
  24. Total Sperm Count
  25. (X 1 Million per ml)                                >= 40
  26. Total Motile Sperm
  27. (X 1 Million per ml)                                >= 20
  28. White blood cells
  29. (X 1 Million per ml)                                <= 1
  30. Agglutination (0, 1, 2, 3)
  31. Clumping of sperm to sperm                          0
  32. Clumping of sperm to round cells                    0
  33. % Normal Morphology                                 >= 50%
  34. Penetrak Score (mm)                                 >= 30
  35. ------------------------------------------------------------------------------
  36.   ml = milliliter
  37.   mm = millimeter
  38.   <= = Less Than or Equal to
  39.   >= = More Than or Equal to
  40.