Reproductive health is a significant concern for many couples trying to conceive, with male factors accounting for approximately half of all infertility cases. Sperm quality and function are frequently the focus of evaluation when conception is not achieved after a year of regular, unprotected intercourse. Navigating the medical field to find the right specialist for these issues can be confusing due to the specialized nature of the care required. Addressing male fertility concerns requires finding a physician who understands the complex biology of the male reproductive system and can diagnose and treat underlying issues.
Identifying the Male Fertility Specialist
The doctor most accurately described as a “sperm doctor” is a Urologist who has undergone specialized training in male reproductive and sexual health. This sub-specialist is often referred to as an Andrologist or a Reproductive Urologist. Andrology is a field of medicine that focuses exclusively on male health conditions, similar to how gynecology focuses on female health.
While all urologists treat conditions of the male reproductive tract, the Andrologist dedicates their practice to male infertility, hormonal disorders, and sexual dysfunction. Their advanced training equips them to manage complex issues like low sperm counts or testicular failure. These specialists are distinct from Reproductive Endocrinologists (REs), who are typically gynecologists specializing in fertility and hormonal issues for both sexes.
The Andrologist serves as the male partner’s dedicated physician within the fertility team, providing assessment and treatment focused on optimizing sperm production and delivery. They are uniquely positioned to perform surgical procedures necessary to correct anatomical or obstructive causes of infertility. Consulting this specialist ensures the male factor is thoroughly investigated and treated, rather than simply bypassing the issue with assisted reproductive techniques alone.
Diagnostic Tools and Procedures
The initial step in evaluating male fertility is the Semen Analysis, a laboratory test that assesses key parameters of the ejaculate. Physicians use World Health Organization (WHO) criteria to determine if sperm count, motility, and shape fall within the expected range. Current standards indicate a sperm concentration of at least 16 million sperm per milliliter and a total motility of 42% or higher.
The analysis also examines sperm morphology, requiring at least 4% of sperm to have a normal shape. If the semen analysis is abnormal, the specialist will order blood tests to assess the hormonal environment regulating sperm production. These tests commonly measure Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), and Testosterone.
FSH and LH are pituitary hormones that stimulate the testes to produce sperm and testosterone, respectively. Abnormal levels can indicate a problem in the brain-testes signaling axis. Physical examination and imaging, such as a scrotal ultrasound, can identify anatomical issues like a varicocele or obstruction. Further investigation might include genetic testing, such as karyotyping or Y-chromosome microdeletion testing, to uncover inheritable causes of sperm production failure.
Treatment Pathways for Sperm Health
Treatment for male factor infertility is tailored to the underlying cause, ranging from non-invasive changes to surgical intervention. Lifestyle modifications, such as managing weight and stopping smoking, along with specific medications or hormone therapy, may be recommended to improve sperm parameters. For men with hormonal imbalances, treatment can involve medication to stimulate the body’s own production of testosterone and sperm.
One common surgical target is the varicocele, an enlargement of veins within the scrotum. This condition is believed to harm sperm by elevating testicular temperature and increasing oxidative stress. Varicocele repair, often performed microsurgically, seals off the abnormal veins, which can lead to improved sperm concentration and motility.
In cases where sperm is not present in the ejaculate (azoospermia), the specialist may perform a surgical sperm retrieval procedure.
Surgical Sperm Retrieval
Testicular Sperm Aspiration (TESA) uses a needle to aspirate fluid and tissue. Testicular Sperm Extraction (TESE) involves a small surgical biopsy to locate sperm directly within the testicular tissue. The retrieved sperm are then used in Assisted Reproductive Technologies (ART), most often via Intracytoplasmic Sperm Injection (ICSI), where a single sperm is injected directly into an egg.