2.1 KiB
2.1 KiB
type, category, person, date, provider, source
| type | category | person | date | provider | source |
|---|---|---|---|---|---|
| lab_report | andrology | Yanxin Lu | 2026-01-17 | Advanced Reproductive Technologies, LLC / ART LLC | 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
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Printed: 1/17/2026