Andrology Services at University Hospitals Birmingham

COVID UPDATE:  The andrology service will be running clinics with reduced capacity from 1st July 2020.  Please ensure the appropriate clinical information is given on the referral so that these can be appropriately triaged. 

The User Handbook can be accessed here:  Andrology User Handbook

The Andrology Laboratory at University Hospitals Birmingham (UHB) is a UKAS Accredited Service (ISO15189:2012), currently operating from a single site located on the 1st Floor of the Sheldon Unit at Good Hope Hospital.

The laboratory's priority is to provide a comprehensive semen analysis service for Consultants, Urologists and General Practitioners from the Birmingham and Solihull area. This includes semen analysis for fertility investigations (Diagnostic Semen Analysis), post-operative analysis of semen following a vasectomy operation (Post Vasectomy Semen Analysis) and retrograde analysis of urine.

The laboratory operates on a clinic based service and has a maximum capacity of 2500 appointments available per annum.  This covers the annual workload of routine diagnostic semen analysis, post-vasectomy samples and retrograde ejaculation analysis. Routinely patients will be given an appointment to attend the Andrology Department for on-site sample production in a designated private clinic room, however in exceptional circumstances samples may be produced off site if then able to be delivered to the laboratory within an appropriate time interval. 

The UHB Andrology Laboratory has fully trained scientists who are highly proficient in performing quality diagnostic semen analysis in line with World Health Organisation (2010) and the 2016 Laboratory Guidelines for post vasectomy semen analysis. The laboratory regularly performs internal quality control, participates in the UK National External Quality Assurance scheme for Andrology (UKNEQAS) and liaises with other accredited laboratories for comparison of tests not covered within the UKNEQAS scope.

A laboratory referral can be made via:

  • Paper copy referral forms sent to Appointment Centre via post/e-mail.
  • Electronic Referral Service (e-RS)

 A copy of the referral form can be obtained by;

Contacting the laboratory directly on 0121 424 9717

Or by downloading from here Andrology Referral Form

Or by GP’s accessing the word version at: http://www.heartofengland.nhs.uk/gps/ 

Off-site production can be arranged by the patient by telephoning the laboratory on 0121 424 9717 or by e-mailing This email address is being protected from spambots. You need JavaScript enabled to view it. (if you e-mail you are accepting that the connection is not secure and potentially not confidential – laboratory staff will minimise data transmission but cannot guarantee security).  Please note that retrograde urine production cannot be undertaken off-site.  This must be on-site at Good Hope Hospital.

Turnaround Time: 7-10 days (electronic reporting may be more rapid). Paper copies currently sent. This is due to validation of reports by a second scientist.

Anti-sperm antibodies (ASAB) not tested at this laboratory. Agglutination is described if noted.

Please see user handbook for additional information including contact details.

Accreditation information can be found at:

https://search.ukas.com/#/tabbed/search?q=andrology

Post-vasectomy Semen Analysis (PVSA)

The laboratory undertakes examination procedures in line with the following guidelines:  2016 PVSA Guidelines.  This will give clinicians information regarding clearance criteria. 

Results are avialble to Hospital clinicians via the two portals:

  • PICS - QEHB
  • Concerto/ICE - HGS

GP's can access patient results through their own electronic result systems, although paper copy reports are sent out following result authorisation.

Key details of the service:

  • Operates Monday to Friday 08:00am to 16:00pm
  • Undertakes diagnostic semen analysis, post vasectomy analysis and retrograde examination (urine)
  • Appointment based with on-site room for sample production
  • 7-10 day turnaround time (electronic and paper copy reporting)
  • Patients are booked within 7 weeks from referral, unless clinically indicated or by patient choice

Andrology Changes to Service or Notifications

Changes to Post-vasectomy semen analysis from 1st September 2019

Queen Elizabeth Hospital will no longer analyse semen samples for vasectomy success confirmation from the 1st September 2019.  A referral form must be completed and sent to the appointment centre for the patient to be given an appointment to attend at Good Hope Hospital.  All samples received into Pathology at Queen Elizabeth following this date will be rejected.  Please contact the laboratory if you require any further information. 

Changes to the Reporting of Oligozoospermia

Andrology will change the way in which oligozoospermia is reported from 1st April 2019.  Oligozoospermia was previously only reported when the total number of spermatozoa per ejaculate was <39 million.  The new reporting procedures will include oligozoospermia for any results where there is <15 million per ml (the concentration) and/or total numbers of spermatozoa in the ejaculate <39 million.  This will help referrers understand what may be used for subsequent management whilst also giving them important information regarding the functioning of the male reproductive tract.

The use of alpha-chymotrypsin, a broad-spectrum proteolytic enzyme for diagnostic semen analysis samples has been ceased for motility assessments unless under rare circumstances.

Retrograde Examination Procedure

Retrograde analysis is available at Good Hope Hospital.  This will assess numbers of sperm and motility (if present).  Morphology is not assessed as part of this examination.  The test was assessed by UKAS for accreditation to ISO15189:2012 on 21/01/2020 and is now included as an accredited test. 

If you require any further information, please contact Mr Stuart Long on 0121 424 9717 or Email This email address is being protected from spambots. You need JavaScript enabled to view it.

Biochemical Profiles

Liver function

Protein, Albumin, Bilirubin, ALT, ALP with GGT automatically reflex tested if ALP > 200

Renal/Electrolytes

Sodium, Potassium, Urea, Creatinine


Cardiac

Troponin I

Lipid

Cholesterol, Triglyceride

Bone

Calcium, Phosphate, ALP, TP, Alb

Clinical Advice and Test Interpretation (Haematology)

The clinical service is consultant-led and available on a 24-hour basis to hospital clinicians and GPs.

For the clinical interpretation or advice of any haematology test results please contact the on-call SpR or Consultant via switchboard - 0 from an internal telephone or 0121 424 2000 if phoning from outside of the Trust.

Please click on the link for the following guidance

GP Investigation and Referral Pathways for Leucocytes, Platelets and Polycythaemia

Investigation and Referral Pathways for Anaemia in Primary Care

Investigation of Paroxysmal Nocturnal Haemoglobinurea

Diagnostic algorithm for investigation of possible Gaucher’s disease in adults

Criteria for Referral to Haematology

Criteria for telephoning critical haematology results

 

Clinical Allergy Services

Specific IgE ("RAST")

Measurement of IgE to specified allergens can help to confirm allergies suspected on clinical grounds.  Results must be interpreted in the context of a detailed clinical history, and neither positive or negative results are diagnostic in isolation.  The allergens to be tested must be specified on the request.  This test is not suitable for broad "allergy screening" in the absence of a history suggestive of an allergic reaction.

Skin Prick Testing

In many cases skin prick testing provides a safe and simple alternative to specific IgE measurement, but this does require referral.

Referrals are accepted for the investigation and management of patients who have suffered anaphylaxis and patients with the the following allergic conditions:


Urticaria/Angio-oedema

Clear allergic precipitants can be identified in only a small proportion of cases.  Patients may respond well to regular treatment with antihistamines.

Food Allergy

Skin-prick testing for a range of food allergens is available.  "Screening" is not appropriate, and diet and symptom diaries often help to identify suspected foods for testing.  Patients with life-threatening reactions benefit from detailed advice and individualised management plans.

Allergic Rhinitis and Asthma

Skin prick testing can help to identify significant aeroallergens in these patients, which may held in planning medical management.  Pollen desensitisation may be offered under certain circumstances: patients will only be considered if adequate medical therapy has failed, and certain other suitability criteria are fulfilled. 

Bee/Wasp Venom Allergy

Assessment of patients who have suffered severe reactions to bee or wasp stings is offered.  In some cases desensitisation immunotherapy is indicated to prevent anaphylaxis in individuals at particular risk.

Antibiotic and Anaesthetic Allergies

Suspected antibiotic allergy (especially to penicillin) is common, and can usually be circumvented by the choice of an alternative antibiotic.  In exceptional circumstances allergy testing may be appropriate.  It is often important to exclude or identify allergy to local and general anaesthetic agents, so that future routine or emergency treatment can be given safely.  A detailed history of the suspected anaesthetic reaction and the anaesthetic agents used are vital to successful assessment. Testing of serum tryptase levels immediately after an anaphylactic episode often aids diagnosis (see Laboratory Services).

Clinics

Glucose Tolerance Tests

Appointments can be made via Diabetes Centre on 0121 424 0234.  A service is available at Solihull - for information contact Laboratory Reception at Solihull on 0121 424 5531 / 0121 424 5526.

Connective Tissue Disease and Vasculitis

Blood tests to help in the investigations of these conditions are listed below and a guide to their use may be found in Test Profiles.

Connective Tissue Disease

This covers a wide range of relatively rare conditions including systemic lupus erythematosus (SLE), scleroderma, polymyositis and Sjorgren's syndrome.  Rheumatoid arthritis is common, and may present initially with similar features.  However, the early involvement of other organs (e.g. skin, kidneys, eyes, Raynaud's) may suggest an alternative diagnosis.

Vasculitis

Includes a heterogeneous group of diseases, characterised by inflammation and necrosis of blood vessel walls.  Presenting features may include fever, weight loss, fatigue, multi-system involvement (skin, nasal bleeding/crusting, arthralgia, myalgia, neuropathy), with raised inflammatory markers and abnormal urinalysis.  As with connective tissue disease, rapid diagnosis and treatment is essential to prevent organ damage and death. Serological markers such as ANCA may be helpful, but are not diagnositc and their absence does not exclude vasculitis.  Biopsy evidence of vasculitis is always preferable to confirm the clinical suspicion.

Clinical advice regarding the management of these conditions may be obtained from the department Medical Staff, or from the relevant clinical specialty (e.g. renal, medicine, rheumatology).  Patients may be referred to Immunology or to Rheumatology for assessment.

Advice for Medical Practitioners

Advice regarding the investigation, treatment or referral of all patients with possible connective tissue disease and vasculitis is available from the medical staff.  Advice out of normal working hours can be obtained from the on-call rheumatology, renal or medical teams (depending on the patient's particular problem).

Fluid Analysis Guidelines

Only the fluid types below and specific analyses tabled are now allowable in Telepath and ICE. Where a fluid type or analysis is not allowable in Telepath please book as miscellaneous and then contact the Duty Biochemist before analysis is performed.

All fluids must be centrifuged and then analysed only if free from particles.

Haemoglobin A1c and the diagnosis of diabetes mellitus

Conventionally diabetes mellitus has been diagnosed by high fasting or random blood glucose concentrations, or abnormal oral glucose tolerance tests (OGTT). Haemoglobin A1c (HbA1c) has been used to monitor longer term glycaemic control in patients with known diabetes mellitus.

In 2011, the World Health Organisation (WHO 2011) recommended that HbA1c measurements should also be used to diagnose diabetes in the majority of asymptomatic individuals, and this recommendation has been agreed in the UK (NHS Diabetes 2011).

HbA1c of 48 mmol/mol or more (≥ 6.5%) is consistent with diabetes: if the patient has no symptoms then a second HbA1c result must be obtained within 2 weeks, and if ≥ 48 mmol/mol (≥ 6.5%) confirms diabetes mellitus.

HbA1c values of 42 to 47 mmol/mol (6.0 to 6.4%) suggest a high risk of future diabetes. Such individuals should be offered structured lifestyle education and support to delay/prevent development of diabetes, and have an annual HbA1c test

Copyright heftpathology 2013, 2014, 2015, 2016, 2017, 2018

HTA licence number is 12366

Protection of Personal Information – Laboratory Medicine comply with the Trust Data Protection Policy and have procedures in place to allow the Directorate and it’s employees to comply with the Data Protection Act 1998 and associated best practice and guidance.

The Trust Laboratories at Heartlands Hospital, Good Hope Hospital and Solihull Hospital were awarded UKAS (United Kingdom Accreditation Service) accreditation to the internationally recognised ISO 15189 standard in May 2015. For a list of accredited tests and other information please visit the test database http://www.heftpathology.com/frontpage/test-database.html.
Tests not appearing on this scope are either under consideration or in the process of accreditation and so currently remain outside of our scope of accreditation. However, these tests have been validated to the same high standard as accredited tests and are performed by the same trained and competent staff.

For further information contact Louise Fallon, Quality Manager, 0121 424 1235

UKAS Logos