Sperm count is the concentration of sperm cells in semen, measured in millions per milliliter. This measurement, along with sperm shape and movement, indicates male reproductive potential. A sufficient number of healthy, mobile sperm increases the probability of successful conception. Assessing sperm count is often the first step in a comprehensive fertility evaluation for couples facing difficulties achieving a natural pregnancy.
Initial Screening and Referral Pathways
Fertility assessment often begins with established healthcare providers, such as a General Practitioner (GP) or Primary Care Physician (PCP). These professionals serve as the initial point of contact and typically order the preliminary diagnostic test known as a semen analysis.
The semen analysis measures sperm count, semen volume, motility (efficient movement), and morphology (normal shape). If the results of this initial screen are abnormal, or if the couple has been trying to conceive for an extended period, the PCP facilitates a referral to a specialist.
The female partner’s Obstetrician-Gynecologist (OB-GYN) is also frequently involved early in the process. The OB-GYN may suggest testing the male partner and can order the initial semen analysis. If necessary, they initiate the referral for the male to see a specialist for complex diagnosis or treatment.
The Primary Specialist for Male Reproductive Health
The most appropriate specialist following an abnormal semen analysis is a Urologist sub-specialized in male reproductive health, known as an Andrologist. The Andrologist focuses exclusively on the male reproductive system, including infertility, sexual dysfunction, and hormonal imbalances. This specialized training allows them to interpret complex results and develop targeted treatment plans.
The Andrologist performs a comprehensive evaluation, often beginning with a detailed physical exam and medical history. They look for underlying anatomical issues affecting sperm production or transport, such as a varicocele. A varicocele is an enlargement of scrotal veins that can raise testicular temperature, negatively impacting sperm quality and count.
Diagnostic Procedures
Diagnostic procedures may include hormonal blood work to assess levels of testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH), which regulate sperm production. They may also order a scrotal ultrasound to check for structural abnormalities, blockages, or tumors. If tests reveal azoospermia (complete absence of sperm), the Andrologist determines if the cause is obstructive or non-obstructive.
Once a diagnosis is made, the Andrologist treats the underlying condition. Treatment may involve surgical correction of anatomical issues like a varicocele, or medical management of hormonal imbalances with medications to optimize sperm production. Their goal is to improve reproductive health, increasing the chance of natural conception or improving outcomes for advanced fertility treatments.
Coordinating Advanced Fertility Treatment
When male factor infertility is severe or uncorrectable through medical or surgical intervention, a multidisciplinary team collaborates to pursue advanced reproductive technologies. This team is typically coordinated by a Reproductive Endocrinologist (RE), who is a fertility specialist with extensive training in assisted reproductive techniques. The RE works closely with the Andrologist to integrate the male and female treatment plans.
The Reproductive Endocrinologist, who is an OB-GYN with further specialized training, focuses on procedures such as In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI). ICSI is a technique often used for severe male factor infertility, where a single, viable sperm is injected directly into an egg. The Andrologist ensures the highest quality sperm is available for these procedures, while the RE manages the female partner’s cycle and the laboratory aspects of fertilization.
A specialized laboratory team, including Andrology Technicians and Embryologists, plays a unique role in preparing the sperm and handling the resulting embryos. Andrology labs perform advanced sperm testing, such as DNA fragmentation assays, which evaluate the genetic integrity of the sperm. Embryologists are responsible for the complex process of fertilization in the lab, including the selection of the best sperm and eggs, and the monitoring of embryo development.
For men with azoospermia, the Andrologist performs surgical sperm retrieval procedures, which are coordinated with the female partner’s egg retrieval by the RE. Techniques like Testicular Sperm Extraction (TESE) or Microdissection TESE (MicroTESE) involve surgically obtaining sperm directly from the testicle tissue. These procedures require precision and coordination to ensure the retrieved sperm can be immediately used for fertilization.
Genetic Counseling
Genetic Counselors are another specialized member of the team, particularly when severe male factor infertility is diagnosed. Male infertility can sometimes be linked to underlying genetic conditions, such as chromosomal abnormalities or gene mutations. The Genetic Counselor reviews the family history, discusses the risks of passing on certain conditions, and explains the options for genetic testing of the parents or the embryos.