Sperm count is an indicator of male fertility, reflecting the quantity of sperm present in a man’s ejaculate. It plays a role in the ability to conceive, as a higher number of healthy sperm increases the likelihood of successful fertilization. Individuals may become concerned about their sperm count if they experience difficulty conceiving, or if they have other health conditions that could affect reproductive function. Understanding the process of evaluating sperm count and knowing which medical professional to consult can provide clarity and direction.
Starting with Your Primary Care Physician
When concerns about sperm count arise, the initial point of contact is a primary care physician (PCP). A PCP can conduct a comprehensive medical history, inquiring about past illnesses, surgeries, medications, and lifestyle factors. This includes discussions about diet, exercise, smoking, alcohol consumption, and exposure to environmental toxins. A basic physical examination can also be performed.
The PCP can order initial diagnostic tests. This involves a semen analysis, which assesses sperm count, motility (movement), and morphology (shape). Blood tests can also be ordered to check hormone levels, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone, which are important for sperm production. Based on these findings, the primary care physician can offer guidance and, if necessary, facilitate a referral to a specialist.
When to See a Specialist
Referral to a fertility specialist is recommended when initial evaluations suggest complex issues or after a period of unsuccessful conception. If semen analysis results are abnormal, indicating low sperm count (oligospermia) or absence of sperm (azoospermia), a specialist consultation is recommended. Individuals with known medical conditions that affect fertility, such as hormonal imbalances, genetic disorders, or structural abnormalities, should also see a specialist. If a couple has been trying to conceive for one year without success, or six months if the female partner is over 35, a specialist evaluation is recommended.
Two main types of specialists address male fertility: urologists (including andrologists) and reproductive endocrinologists. Urologists specialize in the urinary tract and male reproductive system, diagnosing and treating conditions like varicoceles, blockages, or testicular disorders that affect sperm production or transport. An andrologist is a urologist who has further specialized in male reproductive and sexual health, focusing on male infertility, sexual dysfunction, and hormonal imbalances. Reproductive endocrinologists are fertility doctors who primarily focus on hormonal aspects of reproduction in both men and women, and they often work with urologists for male factor infertility.
Investigations and Next Steps
Once under the care of a fertility specialist, an in-depth diagnostic process begins to pinpoint the cause of infertility. A detailed semen analysis is a primary part of this investigation, evaluating parameters such as semen volume, pH, liquefaction time, sperm concentration, motility, and morphology. Multiple samples are analyzed over time to ensure accuracy due to natural variability.
Hormonal assays provide further insight into the endocrine system’s role in sperm production. Blood tests measure levels of FSH, LH, and testosterone, which are important for testicular function and spermatogenesis. Abnormal levels can indicate issues with the brain’s signals to the testes or problems within the testes themselves. Genetic testing can be performed, especially if sperm counts are very low or absent, to identify chromosomal abnormalities or missing genetic material on the Y chromosome.
Imaging techniques are also used to visualize the male reproductive organs. Scrotal ultrasound can identify structural issues such as varicoceles (enlarged veins), testicular tumors, or epididymal abnormalities. Transrectal ultrasound (TRUS) can be used to assess the prostate, seminal vesicles, and ejaculatory ducts for blockages. In specific situations, a testicular biopsy can be performed to diagnose the cause of absent sperm production or to retrieve sperm directly from the testicles for assisted reproductive techniques. These comprehensive investigations help the specialist determine the underlying cause of male infertility and guide subsequent recommendations.