vault backup: 2026-04-05 15:37:59

documents/medical/scrc/lu_scrc_iui_sample.md

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+---
+type: lab_report
+category: andrology
+person: Yanxin Lu
+date: 2026-01-17
+provider: Advanced Reproductive Technologies, LLC / ART LLC
+source: lu_scrc_iui_sample.jpg
+---
+
+# Intrauterine Insemination Report — Fresh Sample
+
+**Medical Director:** Hal C. Danzer, M.D.
+450 North Roxbury Drive
+Beverly Hills, Suite 500
+CA 90210
+310.277.2393
+CLIA ID#: 05D0546234
+
+---
+
+## Patient & Partner Information
+
+| Field | Value |
+|---|---|
+| Patient Name | XUEWEI (ERICA) JIANG |
+| Patient ID | 105151 |
+| Patient Birth Date | 03/13/1993 |
+| Partner Name | YANXIN LU |
+| Partner ID | 105150 |
+| Partner Birth Date | 10/17/1989 |
+| Accession # | 480706 |
+| Ordering Physician | ART LLC |
+| ID Checked By | ART LLC |
+| Count Tech | DOG |
+
+---
+
+## Procedure Details
+
+| Field | Value |
+|---|---|
+| Date of Procedure | 01/17/2026 |
+| Abstinence Period | Day(s) |
+| Collection Date/Time | 01/17/2026 07:40 AM |
+| Collection Container | Sterile Cup |
+| Collection Method | Ejaculate |
+| Date/Time Recd in Lab | 01/17/2026 08:30 AM |
+| Reported By | |
+| Directed Donor Name | Desta Gebagay |
+
+---
+
+## Sample Analysis
+
+### Pre-Wash Values
+
+| Parameter | Value | Reference Values |
+|---|---|---|
+| Concentration | 3.0 ml | >= 1.5 mL |
+| Motility | 48 Million/mL | >= 15 million/mL |
+| Agglutination | 50% Progressive | >= 40% |
+| Round Cells | None | None-Minimal |
+| Progression | 0 Million/mL | < 1.0 Million/mL |
+| Total Motile Count | 72 M | 2+ to 3+ |
+| Media | 2+/3 | |
+| ALL (Grad Gradient) | | |
+
+### Post Wash Values
+
+| Parameter | Value |
+|---|---|
+| Volume | 0.5 mL |
+| Concentration | 40 Million/mL |
+| Motility | 83% Progressive |
+| Total Motile Count | 16.6 M |
+
+---
+
+**Comments:** Concentration and Motility values confirmed in duplicate
+
+---
+
+## Signatures
+
+**Physician Signature:** Dr. Candice Tilles
+
+**FDA Status:**
+
+**Reviewed and Electronically Signed By:**
+Lab Director: Desta Gebagay, C.L.S, ASCP
+
+**Sample Verification:**
+
+**Patient Signature:** *(signed)*
+
+**Witness Signature:**
+
+**Inseminated By:** *(signature present)*
+
+---
+
+**Test Performed At:** BH - ANDROLOGY
+Intrauterine Insemination Report — Fresh Sample - 1
+
+Powered by eIVF, a PracticeHwy.com product
+
+Printed: 1/17/2026