Cases/Maternity and Reproductive Health

Man Attending to Discuss An Abnormal Semen Analysis — Free SCA Practice Case

Man attending to discuss an abnormal semen analysis

Station Timer

12:00

Golden Minute

Initial Introduction

•Introduce yourself

•Ask an open question — "How can I help you today?"

•Listen — don't interrupt

•Catch early cues

Data Gathering

History, ICE & Diagnosis

Clinical Management

Diagnosis, Plan & Decisions

Safety Net

Follow-up & Close

12:00

Golden Minute

Materials for Candidate

Please review before starting the consultation

Patient Profile

Full Name

Craig Wilson

Age

39 years

Consultation Type

Video

Age

Situation

Video Consultation. The patient has booked a video appointment to discuss his semen-analysis results.

Reason for Encounter

"Hi Doctor, I've come to go through my sperm test results."

Medical Records

●PMH: None recorded.
●Medications: None.
●Allergies: NKDA.
●Recent notes: Telephone consultation 2 weeks ago — he and his wife have been trying to conceive for 2 years; wife under fertility investigation with her GP; semen analysis requested.
●Semen analysis (WHO 2021 reference ranges): Volume 2.0 mL (≥1.4); sperm concentration 8 million/mL (≥16); total count 16 million (≥39); progressive motility 20% (≥32%); total motility 30% (≥42%); vitality 55% (≥54%); morphology 5% (≥4%); pH 7.6; WBC <1 million/mL; no agglutination. Impression: oligoasthenozoospermia (low concentration and reduced motility).

Patient Script

For the friend playing the patient role

Character Overview: You are Craig, a 39-year-old long-distance truck driver. You and your wife have been trying for a baby for two years without success; she is having her own fertility tests, and you were asked to do a sperm test. You are hoping the result is normal. You are a practical, fairly reserved man, and if told your sperm count and movement are low, you will be quietly knocked by it — it touches something about how you see yourself. You have a nine-year-old daughter from a previous marriage. You want to understand the result and what happens next.

Opening Sentence: "Hi Doctor. I'm here to go through my sperm test results. My wife and I have been trying for a baby for a couple of years, and her doctor said I should get tested too. I'm hoping it's all come back normal, to be honest."

History if Asked (Data Gathering Phase)

●The context: "We've been trying for about two years. My wife's having tests with her GP, and they said I should have the sperm test done."
●The test process (only if asked): "I followed all the instructions — abstained for three days, collected it near the lab, handed it straight in."
●Previous children: "I've got a nine-year-old daughter from my first marriage. So I've had a child before, if that helps."
●How he's feeling: "Stressed, if I'm honest. Trying and failing for two years takes it out of you. I've been working extra hours to keep my mind off it."
●Lifestyle (only if asked): "I drive long distances — hours sitting down, I use the heated seats a lot. I don't smoke or drink. I don't exercise much, my diet's not great, and I know I'm carrying too much weight."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores his perspective.

●Ideas: Craig is hoping the result is normal and has not really considered that the problem might be on his side, especially as he has fathered a child before. "I've been assuming it'd be fine — I've got a daughter already, so I figured it wouldn't be me."
●Concerns: His main concern is not being able to have a baby with his wife; beneath that, an abnormal result would hit his sense of himself as a man and add to the couple's strain. "The big worry is that we'll never have a baby together. And honestly, if it's me… that's a hard thing to take in as a bloke."
●Expectations: He wants his results explained and to know the next steps. "I want to understand the result and what we do now."

If Asked — Focused History (with sensitive signposting)

The patient answers these only when directly and sensitively asked.

●If asked about abstinence and sample handling: "Three days' abstinence, collected near the lab, handed in straight away."
●If asked about erectile or ejaculatory problems: "No, no problems in that department."
●If asked about penile curvature: "No, nothing like that."
●If asked about testicular lumps, swelling, or pain: "No lumps or swelling."
●If asked about breast tissue enlargement (gynaecomastia): "No."
●If asked about mumps in childhood/adolescence: "Not that I know of."
●If asked about genital surgery or injury: "No operations or injuries down there."
●If asked about STI history: "Never had an STI. Last screen was clear, a couple of years ago."
●If asked about occupation and heat exposure: "Truck driver — long hours sitting, heated seats on a lot."
●If asked about recent illness: "No, I've been well."
●If asked about exercise, diet, weight, smoking, alcohol, drugs: "No exercise really, poor diet, overweight, non-smoker, don't drink, no drugs."
●If asked about stress: "Very stressed with the whole thing, and working extra to cope."

Responses to Management (The Negotiation Phase)

●If the Doctor explains the results sensitively: "So the count and the movement are low? What could have caused this, doctor?" (The tested point is giving the result clearly and sensitively, and explaining the common, often multifactorial and modifiable, causes.)
●If the Doctor reassures that he has fathered a child and it doesn't mean he can't again: "So it doesn't mean I definitely can't have another child?" (The tested point is honest, proportionate reassurance without over-promising.)
●If the Doctor recommends a repeat test in 3 months: "Why do I have to wait three months to repeat it? Can't we just act on this one?" (The tested point is explaining the ~3-month spermatogenesis cycle and the value of confirming the result.)
●If the Doctor discusses lifestyle changes: "So losing weight and stopping the heated seats could actually help? Where do I start?"
●If the Doctor discusses referral: "What about seeing a fertility specialist — do we both go, or just my wife?"

Mark Scheme

Domain 1: Data Gathering and Diagnosis

0 / 18 indicators checked+0−0

Positive (0/9)

Negative (0/9)

Domain 2: Clinical Management and Medical Complexity

0 / 18 indicators checked+0−0

Positive (0/9)

Negative (0/9)

Domain 3: Relating to Others

0 / 12 indicators checked+0−0

Positive (0/6)

Negative (0/6)

Clinical Learning Points

Interpreting Semen Analysis (WHO 2021)

●Key parameters and lower reference limits (WHO 2021): sperm concentration ≥16 million/mL, total count ≥39 million/ejaculate, progressive motility ≥32%, total motility ≥42%, normal morphology ≥4%, vitality ≥54%, volume ≥1.4 mL.
●Oligoasthenozoospermia = low concentration (oligo-) plus reduced motility (astheno-), as here.

Confirm Before Acting — the 3-Month Rule

●Spermatogenesis takes ~3 months, and semen quality can be affected by temporary factors (illness, stress, heat, collection technique). A single abnormal result should be confirmed by a repeat semen analysis in ~3 months before drawing conclusions.
●Always check the sample was collected correctly (2–7 days' abstinence, prompt correct transport).

Causes — Often Multifactorial and Modifiable

●Contributors include obesity, poor diet, inactivity, smoking, alcohol/recreational drugs, scrotal heat (prolonged sitting, heated seats, tight clothing), stress, and recent illness.
●Less common causes include hormonal (endocrine) problems, testicular pathology, genital infection, varicocele, obstruction, and previous mumps orchitis or genital surgery — hence the focused history and examination.

Lifestyle Modification

●Advise weight loss, a healthier diet, physical activity, avoiding scrotal heat (breaks from driving, avoiding heated seats), stress reduction, and stopping smoking/limiting alcohol where relevant. Small, realistic, sustained changes can improve semen quality and general health.

Further Investigation and Referral

●Persistent abnormalities may warrant hormone profiling (FSH, LH, testosterone) and specialist assessment.
●Subfertility is a couple issue: after ~2 years of trying (or sooner with abnormal results/risk factors), refer to fertility/reproductive services, assessing both partners together.

The Emotional and Identity Dimension

●Male-factor infertility often affects a man's self-esteem and sense of identity, and adds to couple strain. Deliver results sensitively, normalise and de-blame, and offer support — this is a communication-weighted consultation.

Honest, Proportionate Reassurance

●A low count/motility reduces fertility but does not equal sterility; prior fathering is reassuring. Balance genuine reassurance with honesty about the need to confirm and investigate.

Common Candidate Mistakes in This Case

●Insensitive results-giving: delivering the result bluntly, ignoring the impact on his identity.
●Acting on a single sample: not arranging a confirmatory repeat at ~3 months, or not explaining why.
●Conveying blame: judging his weight/lifestyle rather than normalising and engaging him collaboratively.
●Treating it as one person's problem: not framing fertility as a couple issue or arranging joint referral.
●Over- or under-reassuring: either "you're infertile" or a false guarantee, rather than honest, proportionate reassurance.

Free MRCGP SCA practice case for GP registrars covering Man Attending to Discuss An Abnormal Semen Analysis — Maternity and Reproductive Health. Includes candidate brief, patient script, marking scheme mapped to the RCGP SCA marking domains, and learning points. Built directly from the RCGP curriculum topic stations listed under "How this might be tested in the MRCGP SCA," part of a free library of 79 SCA practice cases for simulated consultation assessment preparation.

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