male infertility what can a urologist do for a low sperm count

Understanding Your Treatment Options For Male Infertility

If you and your partner are experiencing difficulties getting pregnant, you may want to consider getting your sperm checked by a urologist. In fact, approximately one third of infertility cases are related issues with the male, one third are due to issues with the female, and one third are related to a combination of issues in both men and women. Meaning that men account for up to 67 percent of infertility cases! However, the reason behind male infertility varies between man to man.

For many, the idea of seeing a specialist for a medical concern such as this can cause anxiety because they don’t know what to expect. But we are here to ease your fears! 

This blog discusses the potential causes of male infertility as well as treatment options and unique solutions available for males suffering from a low sperm count.  

What is Male Infertility?

Male infertility is defined as the inability to conceive after one year of unprotected, adequately timed intercourse.

There are numerous reasons that a man may be considered infertile. However, many of these are due to complications with making or growing sperm.

Related: A Couple’s Guide To Coping With Infertility

Potential Causes of Male Infertility

The most typical causes of male infertility may be:

  • Sperm that isn’t growing fully
  • Sperm that isn’t moving in a particular way
  • Lack of sperm (azoospermia)
  • Sperm is produced in very low numbers (oligospermia)
  • Sperm is blocked due to swelling (varicoceles)

Additionally, genetics, lifestyle factors and previous illnesses or surgeries may influence a male’s sperm production. Typically though, a lack of sperm can be traced back to varicoceles or one of the two forms of azoospermia. 


Varicoceles are swollen veins in the scrotum, and are the most common cause of a low sperm count. About 40 percent of men who report an infertility issue are diagnosed with varicoceles. However, if a couple has already had a child and is struggling to conceive, also known as second infertility, the percentage of patients diagnosed with varicoceles jumps to 80 percent. 

These swollen veins can occur on one or both sides of the testicle, although it’s typically located on the left side. The pooling of blood in the testicles caused by varicoceles warms the testicles too much to produce sperm, which could result in a low sperm count. 


Azoospermia, or the lack of sperm, is another notable cause of male infertility. There are two main reasons why males experience azoospermia. 

  • Non-obstructive azoospermia is caused by the testicles failure to produce sperm. This type of infertility is commonly traced back to genetics, which is important to identify because it may be passed onto future children or cause birth defects. 
  • Obstructive azoospermia is caused by a blockage in the reproductive tract. The blockage could exist in the testicle, epididymis, vas deferens, or ejaculatory duct. A previous vasectomy may also be the cause of obstructive azoospermia. The vas deferens may even be missing, which would require further testing, especially for men who are diagnosed with cystic fibrosis. 

Other Causes

As we mentioned previously, a low sperm count could be due to a number of reasons. While the list of causes below are more unlikely than a varicocele or azoospermia, they are possible and can only be diagnosed by your urologist.

Retrograde ejaculation occurs when the sperm travels into a male’s bladder rather than his penis. Sperm may be completely normal in this case, however, it is unable to reach the vagina. Retrograde ejaculation can be a result of surgery, medications or other health issues. Signs of retrograde ejaculation are cloudy urine after ejaculation and “dry” ejaculation. 

Immunologic infertility is rare, but a potential cause of male infertility. Sometimes, antibodies can attack sperm, preventing them from moving and performing normally, causing a low sperm count. 

Finally, hormones may be the culprit behind a low sperm count. Hormones in the pituitary gland are what instruct the testicles to produce sperm. If a man’s hormone levels are low, it may cause a low sperm count. 

How A Urologist Diagnoses Male Infertility

During your initial visit with your urologist, you and your partner can expect to answer lots of questions. These will be questions about your physical health and medical history, general lifestyle questions, and questions about sexual practices. 

In addition to asking questions, your urologist will perform a physical examination to gather information about your vital statistics and current physical condition. This gathering of information will help your urologist to understand your unique circumstances. 

Men will also be asked to provide a semen sample for a semen analysis. Don’t be surprised if you are asked to complete this test twice — this is common practice and is used to identify the cause of infertility. 

Educational Information About Male Fertility

Once your urologist has collected information about you, he will provide you with some basic educational information regarding male fertility. For example, your urologist may suggest that you avoid hot baths or saunas as the heat may be affecting your sperm count. 

You may be advised as to which lubricants can hinder sperm activity and which do not, so that you can choose accordingly. Along with providing you with pertinent information, your urologist will answer any specific questions that you may have.

Treatment Options for Low Sperm Count

Based on your particular circumstances, your urologist will help you to determine a course of treatment. Treatment may include counseling regarding sexual practices to insure the best timing of intercourse, lifestyle changes such as diet and exercise, hormone therapy, antibiotics if needed for any infections, or surgery to repair any physical abnormalities. There are many courses of treatment for low sperm count, and your urologist will explain the potential benefits and make recommendations.

Typically, obstructions can be located and repaired with minor procedures under local anesthesia. If varicoceles are present, your urologist may recommend a Microscopic Varicocele Repair. A Microscopic Varicocele Repair is completed in office and repairs abnormally dilated veins in the scrotum. 

If a man has had a previous vasectomy and decided to get it reversed, they can undergo a Microscopic Vasovasostomy, also known as a vasectomy reversal. This will allow sperm to pass through the vas deferens once again and increase the likelihood of pregnancy. Click here to see the vasectomy reversal success rates of Dr. Damani, one of our esteemed urologists. 

Unique Solutions for Male Infertility

In more unique situations, such as genetic infertility, more unique infertility treatment solutions for conception may be recommended. 

Your urologist will explain assisted reproductive technology (ART) options if pregnancy is not possible with any course of treatment. Intrauterine insemination (IUI) is a procedure which places the sperm into the uterus. Additionally, in vitro fertilization (IVF) requires harvesting eggs and sperm, placing them together in a petri dish, and transferring them back into the woman’s body. Another option would be intracytoplasmic sperm injection (ICSI), which involves injecting a single sperm into a single egg cell. 

These are the general treatment options that you can expect from your urologist. Of course, each patient is different and your urologist will tailor appointments and treatments to your particular needs. In any case, scheduling an appointment with your urologist is the first step on the path to diagnosing and treating your low sperm count.

If you and your partner are ready to take the next steps towards diagnosing the reason behind potential infertility, download our free guide, Steps to Prepare For Your Upcoming Urology Specialists Appointment. This guide is packed full of resources and steps to help you prepare for your initial appointment. Click the button below to access your copy!

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Content was originally written on September 19, 2014. Content was refreshed on September 10, 2019.