What type of specialist should a patient with concerns about oligospermia (low sperm count) consult?

Specialist Referral for Sperm Count Concerns

Patients with concerns about low sperm count (oligospermia) should be referred to a urologist specializing in male reproductive health. 1

Rationale for Urologist Referral

• The American Urological Association (AUA) and American Society for Reproductive Medicine (ASRM) guidelines specifically recommend that men with abnormal semen parameters or presumed male infertility should be evaluated by a male reproductive expert 1
• A urologist with expertise in male reproduction can:
  • Perform a complete reproductive history and physical examination
  • Order and interpret appropriate diagnostic tests
  • Identify potentially correctable conditions affecting fertility
  • Evaluate for associated health conditions that may impact morbidity and mortality

Diagnostic Approach by the Specialist

The urologist will typically:

1. Obtain a comprehensive reproductive history 1

   • Medical conditions, medications, and environmental exposures
   • Previous fertility history
   • Sexual function

2. Perform semen analysis 1

   • At least two semen analyses obtained a month apart are recommended
   • Parameters assessed include sperm concentration, motility, and morphology
   • Point-of-care and mail-in semen tests are not substitutes for laboratory testing

3. Conduct hormonal evaluation 2

   • Testosterone and FSH levels, especially if sperm concentration is <10 million/mL
   • Additional testing may include LH, prolactin, and estradiol
   • Men with FSH levels >7.5 IU/L have a five to thirteen times higher risk of abnormal semen quality

4. Consider imaging studies when indicated 2

   • Scrotal ultrasonography for testicular masses or varicocele
   • Transrectal ultrasound for ejaculatory duct obstruction or abnormal seminal vesicles

Important Considerations

• Health implications beyond fertility: Men with abnormal semen parameters have higher rates of testicular cancer, and men with azoospermia have higher rates of cancer in general 1

• Treatable conditions: Over 50% of male infertility cases can be attributed to potentially treatable conditions 1

• Avoiding unnecessary treatments: Without proper male evaluation, the female partner may pursue unnecessary costly, time-consuming, and invasive treatment options 1

• Genetic implications: Some conditions have genetic implications for potential offspring 1

Common Pitfalls to Avoid

1. Delaying specialist referral: Early evaluation allows for timely intervention and may improve outcomes

2. Relying solely on home testing kits: These provide limited information and are not substitutes for laboratory testing 1

3. Focusing only on fertility without considering overall health: Abnormal semen parameters may indicate underlying health conditions 1

4. Proceeding directly to assisted reproductive technologies: Identifying and treating underlying causes may allow for natural conception or improve ART outcomes 3

By consulting a urologist specializing in male reproductive health, patients with concerns about sperm count can receive comprehensive evaluation and appropriate treatment, potentially improving both fertility outcomes and overall health.