Sometimes men need help from an expert. Consider consulting with a urologist or other male reproductive specialist in the following circumstances:
Low testosterone. Testosterone (T) is the major male hormone and plays a large role in establishing sex drive, muscle mass, and energy. High levels of intratesticular testosterone are also necessary for normal sperm production. Some men with low testosterone levels have primary testicular dysfunction, in which problems with testicular function can cause inadequate production of both testosterone and sperm. In other men, low testosterone levels can result from problems with the pituitary (the endocrine part of the brain). Pituitary problems can also affect sperm production. In either case, consultation with a reproductive urologist is indicated.
Sexual problems: Sexual problems like erectile dysfunction or difficulty ejaculating can prevent intravaginal ejaculation and make it very difficult to get pregnant naturally. These problems may also indicate an important underlying medical issue. If sexual dysfunction is present, consult with a urologist or other doctor to get some help and get checked out. Fortunately, most sexual problems in men are easily treatable.
Varicoceles: Varicoceles are dilated veins above one or both testicles. They are similar to varicose veins that people commonly develop in their legs as they get older. Varicoceles are common (found in about 10% of men) and are not dangerous. However, they can impair sperm production and cause male infertility by altering the testicular temperature or through other mechanisms. If your sperm quality is abnormal and you are not successful at initiating a pregnancy with your partner within 12 months, you should see a urologist to discuss varicocele surgery. You should also see a urologist if you are having scrotal discomfort or have noticed any physical changes involving your testicles.
Prior surgery. Sometimes inadvertent blockages can result from the groin, scrotal, or testicular surgeries that interrupt sperm transit. Since only a tiny percentage of your ejaculate volume actually comes from your testicles, these blockages usually don’t affect the amount of semen that you ejaculate, and, therefore, often go unnoticed. In addition, sometimes the reason for the surgery in the first place (eg.,. surgery to fix an undescended testicle) is a sign that there could be a fertility problem. Men should consult with an expert in male fertility if they have a prior history of groin, scrotal or testicular surgery and are having difficulty getting their partner pregnant.
Previous sexually transmitted infection. A history of sexually transmitted infection (STI) is relevant to fertility for several reasons. First, it’s important to understand and minimize the potential risks of transmission to a partner during sexual contact. A primary care doctor, infectious disease specialist, or urologist should be consulted for further individualized information. Second, regardless of the risk of transmission, a history of STI can cause blockage of sperm. The reason for this is that some STIs (particularly chlamydia and gonorrhea) can result in scarring within the pathways that carry sperm from the testicles to the penis. Men should consult with an expert in male fertility if they have a prior history of STI and are having difficulty getting their partner pregnant.
