Urology and Male Fertility: When Should You See a Urologist?

What does a urologist actually do?

A urologist is a doctor who diagnoses and treats conditions involving the urinary system and the male reproductive system. Depending on their specialist interests, they may assess the kidneys, bladder, prostate, penis, scrotum and testicles.

Some urologists specialise in andrology, the area of medicine concerned with male reproductive and sexual health. They may investigate male-factor infertility, testicular conditions, problems with erections or ejaculation, varicocele and hormonal or structural issues affecting sperm production.

Not every fertility concern requires a urology referral. In the UK, your GP can usually begin the assessment, arrange or discuss initial tests and refer you to the appropriate NHS fertility, urology, andrology or reproductive medicine service when needed. Local referral pathways and eligibility can vary.

What does urology have to do with male fertility?

Sperm are produced in the testicles, mature in the epididymis and travel through the reproductive tract before ejaculation. Conditions affecting those organs, the blood vessels around them or the hormones controlling sperm production can sometimes affect semen quality or the ability to conceive.

Examples include a varicocele, previous testicular injury or torsion, undescended testicles, obstruction, infection, hormonal problems and the effects of some medicines or medical treatments. External testosterone and anabolic steroids are particularly important to mention because they can suppress the hormonal signals involved in sperm production.

A urologist does not assess fertility from sexual performance alone. Normal libido, erections and ejaculation do not confirm that sperm concentration or movement is within the expected range. Likewise, a lower semen result does not automatically reveal the cause or mean that natural conception is impossible.

When should you see a urologist about fertility?

You may need specialist assessment when there is evidence of a possible male-factor problem or a physical condition requiring examination. Situations worth discussing with your GP include:

• Two or more abnormal clinical semen analyses.
• A very low sperm concentration or no sperm detected in the sample.
• A lump, swelling, persistent ache or change in the size or feel of a testicle.
• A suspected or known varicocele.
• Previous undescended testicles, testicular torsion, significant injury or pelvic surgery.
• Problems with ejaculation or persistent erectile difficulties that affect conception.
• A history of chemotherapy, radiotherapy or another treatment that may affect fertility.
• Current or previous testosterone therapy or anabolic steroid use.
• A possible hormonal or genetic cause of reduced sperm production.

This does not mean that every item on the list requires the same tests or treatment. It means that a clinician may need to look beyond the semen result and assess the wider reproductive picture.

When should you speak to your GP?

The NHS advises couples to contact a GP if pregnancy has not occurred after one year of regular unprotected sex. The NHS guidance on low sperm count advises seeking help after six months when the female partner is aged 36 or over. You should also ask for help sooner if either partner has a known reason to be concerned about fertility, such as previous cancer treatment or a possible STI.

Where possible, attend the initial appointment together. Fertility can be affected by either or both partners, and assessing only one person can delay the right next step.

You do not need to wait for a year if you have a testicular lump, persistent swelling, significant pain or another physical symptom. Those symptoms should be assessed on their own merits rather than treated only as fertility concerns.

Which testicular symptoms need urgent attention?

Sudden, severe testicular pain is a medical emergency. Go to A&E immediately or call 999 if the pain is sudden and severe, occurs with nausea, vomiting or abdominal pain, lasts for more than an hour, or continues while you are resting. One possible cause is testicular torsion, in which the testicle twists and its blood supply is restricted. Read the NHS guidance on testicular pain.

Arrange a GP assessment for a lump, swelling, a change in shape or feel, one testicle becoming larger, or an ache that does not go away. Most testicular lumps and swellings are caused by something less serious, but the NHS advises that they should always be checked.

A home sperm test cannot identify the cause of testicular pain or diagnose torsion, infection, cancer, a cyst or varicocele. Never delay medical care while waiting to produce or repeat a semen sample.

What happens at a male fertility appointment?

The exact appointment depends on your symptoms, results and local service. A clinician may ask about:

• How long you have been trying to conceive and any previous pregnancies.
• Your medical, surgical and sexual health history.
• Childhood conditions such as undescended testicles or mumps affecting the testicles.
• Medication, testosterone, anabolic steroids and recreational drugs.
• Smoking, alcohol and occupational exposure to heat or chemicals.
• Erections, ejaculation, libido and any pain.
• Relevant fertility or genetic conditions in your family.

This can feel personal, but the questions help the clinician identify which investigations are relevant. Be direct about medicines, supplements and hormone use. Withholding information can make the result harder to interpret.

Will the urologist examine you?

A physical examination may be appropriate, particularly after repeated abnormal semen analyses or when you have symptoms. The clinician may assess the size and position of the testicles, the epididymis and spermatic cords, and look for signs of a varicocele or another scrotal condition.

The 2026 NICE fertility guideline recommends offering examination of the scrotum and testes to people with male reproductive organs after two or more abnormal semen analyses. The same guideline says clinicians should consider measuring testosterone and gonadotrophin hormones in this situation.

The clinician should explain the examination and obtain your consent. You can ask what they are checking, request a chaperone and say if you need the examination to pause.

Which male fertility tests might be recommended?

Semen analysis

Semen analysis is the main first-line test for male-factor fertility problems. A full laboratory analysis may report semen volume, sperm concentration, total sperm number, motility, vitality and morphology. Results are compared with reference values, but these are not a simple border between “fertile” and “infertile”.

NICE recommends a repeat confirmatory test when the first clinical semen analysis is abnormal. This is ideally performed about three months later to reflect a new cycle of sperm production, although severe sperm deficiency should be reassessed sooner.

Hormone tests

Blood tests may include testosterone and gonadotrophins such as FSH and LH. These hormones help control testicular function and sperm production. Results need clinical interpretation: a testosterone result alone does not explain every fertility problem.

Ultrasound or other imaging

A scrotal ultrasound may be used when an examination identifies a lump, swelling or another finding that needs clarification. Imaging is not automatically required for every lower semen result.

Genetic or specialist tests

People with no sperm or a very low sperm concentration may be offered additional investigations depending on the clinical findings. These can include genetic tests or further assessment of the reproductive tract. They are specialist decisions, not routine add-ons for everyone checking sperm health.

What about sperm DNA fragmentation testing?

The 2026 NICE fertility guideline says not to offer sperm DNA fragmentation testing routinely. NICE concluded that the link with subfertility and the benefit of treatment remain uncertain. Be cautious of treating an expensive additional test as an essential first step without a clear clinical reason.

Can you start with an at-home sperm test?

An at-home test can be a practical first look at selected semen parameters, particularly if privacy, convenience or establishing a baseline matters to you. The ExSeed at-home sperm test measures sperm concentration, motility, semen volume and total motile sperm count and allows results to be tracked over time.

However, home testing and clinical assessment answer different questions. An at-home result cannot examine you, diagnose a varicocele or obstruction, check your hormones, test for STIs, assess every semen parameter included in a full laboratory analysis or identify the medical cause of an unexpected result.

Use home testing as information, not as permission to ignore symptoms. If the result is unexpectedly low, follow the instructions carefully and consider repeat testing under comparable conditions. Speak to a healthcare professional if results remain concerning, if you have relevant medical history, or if conception is taking longer than expected.

Before collecting your sample, read how to prepare for a male fertility test. For more detail on the measurements, see our complete guide to sperm testing.

How should you prepare for a semen test?

Preparation can affect the result. Follow the instructions provided by your clinic or test manufacturer rather than mixing guidance from different sources. Important details include the requested abstinence period, collecting the complete sample, avoiding contamination and analysing or delivering the sample within the specified time.

If you repeat a home test to track change, try to keep the preparation and collection conditions comparable. Semen parameters naturally vary, so consistency makes trends easier to interpret. Learn more about natural variation in semen quality and how often to test your sperm health.

Can lifestyle changes replace a urology appointment?

No. Supporting your general health is worthwhile, but diet, exercise, supplements or reducing heat exposure cannot diagnose or correct every cause of male-factor infertility. A structural obstruction, significant varicocele, hormonal condition, genetic issue or testicular disease requires appropriate assessment.

Lifestyle changes also take time to be reflected in sperm production. Avoid claims that one food, supplement or short-term routine can guarantee a higher sperm count or pregnancy. If you are making changes, use them alongside—not instead of—medical advice when clinical concerns are present. Our guide explains evidence-informed ways to support sperm count naturally.

What should you take to your appointment?

• Copies or screenshots of previous semen reports, including dates and abstinence periods.
• A list of prescribed medicines, supplements, testosterone or steroid use.
• Details of previous operations, infections, injuries and cancer treatment.
• A brief timeline of how long you have been trying to conceive.
• Questions you want answered, including what happens after an abnormal result.

If you use an at-home test, bring the full report rather than only describing the result as “normal” or “low”. The actual measurements and collection conditions provide more useful context.

The takeaway

A urologist can help when male fertility concerns extend beyond a single semen number. They may investigate physical, hormonal or reproductive causes, interpret repeated abnormal results and recommend appropriate treatment or referral.

For many UK men, the first step is a GP appointment or an initial semen assessment. Home testing can make sperm health easier to explore, but it does not replace urgent care, a physical examination or a complete clinical fertility work-up.

Know the warning signs, keep a record of your results and ask for help when something changes. Urology Awareness Month is a useful reminder that embarrassment should never stand between you and appropriate care.