Specialty Content

Andrology specialty

Andrology covers semen analysis, sperm function, cryopreservation, and fertility-investigation workflows under HFEA regulation.

Where the content lives

• The Andrology Laboratory — /andrology-lims — the full laboratory simulation: Worklist, Bench, Interpret, Learn. Sample receipt and the sixty-minute clock, concentration on an improved Neubauer chamber, motility in the four WHO grades, strict morphology, vitality and the extended tests, autoverification and what a laboratory may release, what a reference limit actually means, and the post-vasectomy, cryopreservation and assisted-conception pathways
• Specialty page — /andrology-interviews — guides, simulators and case studies, with the link into the Interview Explorer question bank (Bands 2 to 8)
• Result Interpretation (andrology) — open /result-interpretation and click the Andrology card — WHO semen analysis criteria, morphology and motility
• Specialist Portfolio (Andrology) — /portfolio → choose the Haematology & Transfusion Science discipline card, then select Specialist Diploma in the AI Assistant tab

Key competencies covered

• WHO 2021 semen analysis criteria — current 6th edition reference values
• Sperm morphology assessment — strict Kruger criteria
• Sperm motility grading — four grades (a: rapidly progressive, b: slowly progressive, c: non-progressive, d: immotile), reported against the three categories PR, NP and IM, where progressive motility is a + b. The four grades were the WHO 4th edition, dropped by the 5th in 2010 because rapid and slow progression could not be told apart reproducibly by eye, and reinstated by the 6th edition in 2021. A candidate who says they were dropped in 2010 is right about 2010 and a decade out of date about now
• Cryopreservation techniques — slow-freeze, vitrification
• Anti-sperm antibody testing — direct and indirect IBT, MAR
• Surgical sperm retrieval (SSR) — TESE, PESA, MESA handling
• Sperm function tests — HOS, DNA fragmentation
• Quality control in andrology — replicate agreement, Bland-Altman analysis, the Westgard rules, UK NEQAS Andrology
• Post-vasectomy semen analysis (PVSA) — the 2016 guideline: a minimum of 12 weeks after surgery and a minimum of 20 ejaculations, a single azoospermic sample sufficient for clearance, and special clearance for rare non-motile sperm below 100,000 per mL on a second sample
• What a reference limit is — the 5th centile of men whose partners conceived within twelve months, not a line between fertile and infertile
• HFEA regulatory requirements — licensed activities, traceability, witnessing

Bands progression

• Band 5 (£32,073-£39,043) — qualified BMS performing routine semen analysis under HFEA traceability, basic cryopreservation
• Band 6 (£39,959-£48,117) — specialist morphology assessment, complex case analysis, validation, training; usually requires Specialist Portfolio in Andrology
• Band 7 (£49,387-£56,515) — Person Designate or Person Responsible duties under HFEA, governance, audit

Standards alignment

• WHO laboratory manual for the examination and processing of human semen, 6th edition (2021) — the reference limits are the 5th centile of a reference population of fertile men, and the manual explicitly rejects reading the 5th centile as a threshold. It also reinstated four-category motility grading
• ARCS, Good practice in laboratory diagnostic andrology (2024) — the Association of Reproductive and Clinical Scientists. Builds on the WHO 6th edition and ISO 23162:2021, and tells laboratories seeking UKAS accreditation that motility is now assessed as four grades
• ISO 23162:2021 — Basic semen examination: specification and test methods, the standard governing the examination itself
• 2016 Laboratory guidelines for post-vasectomy semen analysis — Association of Biomedical Andrologists, British Andrology Society and British Association of Urological Surgeons, in the Journal of Clinical Pathology. 12 weeks, 20 ejaculations, one azoospermic sample. Note that in 2020 the first two of those bodies merged with the Association of Clinical Embryologists to form ARCS, so a guideline attributed to the ABA or the BAS is not out of date — the body that wrote it has a different name now
• NICE NG257 — Fertility problems: assessment and treatment (March 2026), which replaced CG156. Note that NICE NG156 is abdominal aortic aneurysm and has nothing to do with fertility; it is a common miscitation
• HFEA Code of Practice, 9th edition (version 9.4, effective 1 October 2024) — licensed activities, traceability and witnessing
• UK NEQAS Andrology scheme requirements
• ISO 15189:2022 — the quality framework, which since this edition also covers point-of-care testing
• EUTCD (EU Tissues and Cells Directive — retained UK law post-Brexit)

Common interview question themes (Band 5-7)

• "Walk me through your semen-analysis QC programme"
• "How do you handle a sample with very low count for cryopreservation?"
• "What does WHO 2021 change vs the 2010 edition?" — four of the seven lower reference limits moved, and four-category motility grading came back
• "A man's concentration is 14 million per mL, just under the limit. Is he infertile?"
• "A post-vasectomy sample at eight weeks has no sperm in it. Can you give clearance?"
• "How is patient traceability maintained in andrology under HFEA?"
• "Describe how you would respond to a NEQAS Andrology failure"

Note on terminology

• Azoospermia vs no sperm seen — "no sperm seen" is what one uncentrifuged preparation shows. Azoospermia is a diagnosis, made on a centrifuged pellet and confirmed on a second sample, and it changes what is offered to a couple
• Asthenozoospermia vs necrozoospermia — reduced motility versus dead sperm. They produce the same motility figure and only a vitality stain tells them apart, which is why vitality is reflexed below 42% total or 30% progressive motility
• Clearance vs special clearance — clearance follows an azoospermic sample with the criteria met. Special clearance is a clinical decision by the surgeon for rare non-motile sperm below 100,000 per mL on a second sample, and neither is ever given if any motile sperm are seen
• PR / NP / IM — progressive, non-progressive and immotile; PR is grade a plus grade b

Working the laboratory at /andrology-lims first, then Practice Tests filtered to Andrology + your target Band alongside the Result Interpretation module, gives strong technical preparation.