GOSWAMI FERTILITY CENTRE
DISCHARGE CARD
PATIENT NAME: USHA AGE years: 28 Y, 3M, 28D
HUSBAND NAME: VIKRAM KUMAR AGE years: 28 Y, 9M, 17D
SERIAL NO. 171 UHID: IVFU546
Doctor Date & Time Abstinence (Days) Produced at
[Link] BANSAL GOSWAMI 18/10/23 & 09:57 AM - [] Centre [ ] Home
IUID
Technique: Swim Up
Pre wash Post wash
Volume (ml) 1.5 ml 0.2ml
Sperm count (mill/ml) 89mill/ml 110 mill/ml
Progressive motility 63% 77%
(%)
Viscosity [X] [X]
Agglutination [X] [X]
Debris [] [X]
Head Mid-Piece Tail
Amorphous Cytoplasmic droplet Coiled tail
Elongated Others Short tail
Pyriform Hairpin tail
Macrocephalic Double tail
Microcephalic Others
Broken neck
Double head
Others
Hypo-osmotic
Swelling Test: %
Semen Frozen: [ ] Yes [] No. of Vials Frozen: NA Location: NA
No
Remark : Acceptable []/Not acceptable [ ]
Dr Shakuntla
Verma
Procedure: Satisfactory
Not Valid for Medico Legal Purpose. All Tests Have Technical Limitations.
For Any Discrepancy Kindly Repeat Test Immediately.
DR. ANIKA MOHAN GOSWAMI
M.B.B.S, M.S, F.R.M
GOSWAMI FERTILITY CENTRE
IN-CHARGE
GOSWAMI FERTILITY CENTRE