Urologist for Male Fertility: Diagnosis & Treatment in Ontario
Why You May Need a Urologist When Trying to Conceive
Male fertility is a vital part of every couple’s family-building journey — yet it is often overlooked. In Canada, infertility affects -approximately 15% of couples, and research shows that male-factor infertility is involved in up to 50% of cases, either as the primary cause or as a contributing factor (Source: Fertility Matters Canada; Canadian Urological Association Journal, 2015).
Understanding male reproductive health — and knowing which specialist to see — is essential. This is where a urologist, and more specifically a reproductive urologist (also known as an andrologist), plays a central role in evaluating and treating conditions that affect sperm production, hormonal health, and male reproductive function.
How to get a referral to Dr DiCostanzo
- Patients of Markham Fertility Centre - Ask your MFC physician about a referral
- If you are not a patient of Markham Fertility Centre - Contact Dr DiCostanzo's Stouffville office at 905 591-0006 or Fax to 905 591-0014
Welcoming Dr. John Di Costanzo to
Markham Fertility Centre
We’re excited to announce that Markham Fertility Centre is partnering with Dr. John Di Costanzo of Markham Stouffville Hospital (MSH) who will now consult with our patients on a regular basis. With over 20 years of expertise and compassionate approach to reproductive and urological health, Dr. Di Costanzo brings a valuable new dimension to our clinic’s patient care.
Dr. Di Costanzo will be available for male-factor fertility assessments, consultations, and specialized care — giving our patients more comprehensive and convenient access to expert care onsite at our clinic. Whether for routine fertility evaluations, complex diagnoses, or follow-up treatment planning, having Dr. Di Costanzo on our team means quicker access, better continuity of care, and an even stronger support system for couples on their fertility journey.
At Markham Fertility Centre, we believe in providing holistic, patient-centred care. Bringing Dr. Di Costanzo into our team underscores this commitment — offering additional expertise to help couples navigate fertility challenges with confidence, compassion, and clarity.
What is a urologist? And how can they improve male fertility?
A urologist is a physician‑surgeon who diagnoses and treats disorders of the urinary tract and the male reproductive system. When fertility concerns arise, a reproductive urologist (sometimes called an andrologist) becomes particularly important: they have specialized training in evaluating male reproductive function, identifying underlying male‑factor issues, and managing treatments — medical, surgical, or through assisted reproductive technology (ART) — as needed.
Because many male fertility issues are often treatable, and because male-factor infertility contributes significantly to a couple’s overall fertility picture, involving a urologist early in the fertility care team can meaningfully influence outcomes. A 2022 review published in Journal of Clinical Medicine concluded that collaboration between reproductive endocrinologists and qualified male reproductive urologists “enhances assisted reproductive technology (ART) outcomes,” improves health for infertile men, and can lead to more cost‑effective care (Source: PMC)
Urologists diagnose and treat a wide range of conditions, including:
- Testicular, prostate, and penile disorders
- Urinary tract infections
- Functional and structural bladder disorders
- Kidney stones
- Sexual, ejaculatory and reproductive health concerns
Because the urinary and reproductive systems in men are so closely connected, urologists are trained to evaluate both — uniquely positioning them to evaluate male fertility in the most comprehensive way.
General Urologist vs. Reproductive Urologist
A general urologist manages the full range of urinary system and male genital tract health conditions.
A reproductive urologist (often also called an andrologist) has advanced training and clinical focus on:
Male Fertility & Reproductive Function
This includes expertise in:
- Sperm production and testicular function
- Abnormal semen analysis results
- Varicocele (dilated veins in the scrotum)
- Obstructive or non-obstructive azoospermia (no sperm present in the ejaculate)
- Hormonal causes of male infertility
- Genetic causes of male infertility
- Erectile dysfunction and ejaculatory problems
- Male fertility surgery and sperm retrieval
Clinical evidence shows that involving a reproductive urologist early on can significantly improve outcomes, especially before beginning treatments like IUI or IVF (Source: Journal of Clinical Medicine, 2022).
Common Male Factor Issues Diagnosed by Urologists
Definitions + Clinical Significance
These are several of the most frequently encountered male‑factor issues that can impact fertility — and which a urologist is equipped to identify, evaluate, and treat:
| Issue / Condition | Definition / What It Means | Why It Matters / Impact on Fertility |
| Low sperm count (Oligozoospermia) | Semen analysis shows a lower than normal concentration of sperm per mL. | Fewer sperm reduces the chances of fertilization; may point to testicular dysfunction, hormonal imbalance, prior medical history (Source: PMC). |
| Low motility (Asthenozoospermia) | High proportion of sperm are non‑motile or poorly motile (i.e. poor movement). | Sperm must swim to reach and fertilize the egg — poor motility impairs that ability (Source: PMC). |
| Abnormal morphology (teratozoospermia) | A high percentage of sperm have abnormal shape or structure. | Even with normal count & motility, abnormal morphology can impair fertilization potential (Source: PMC ). |
| Oligoasthenoteratozoospermia (OAT) | Combined abnormalities in sperm count, motility and morphology. | OAT significantly reduces the likelihood of natural conception and often indicates an underlying testicular or systemic cause (Source: AUA). |
| Azoospermia (No sperm in ejaculate) | Absence of sperm in ejaculated semen sample. Further classified as Obstructive azoospermia (OA) when sperm production is normal but there is a blockage; or Non- Obstructive azoospermia (NOA) when no sperm is being produced. | Distinction between obstructive and non-obstructive azoospermia is critical as it determines prognosis and treatment options (Source: CUA Guideline). |
| Ejaculatory / ejaculatory‑tract dysfunction | Issues with ejaculation: low semen volume, absence of semen, anatomical blockages, or dysfunctional ejaculatory ducts. | Even if sperm production is normal, blockage or ejaculatory problems can prevent sperm from being present — causing infertility despite normal testicular function (Source: AUA Network). |
| Hormonal Imbalances (e.g. hypogonadism, endocrine issues) | Disruptions in hormone levels — e.g. testosterone, FSH, LH — affecting sperm production or ejaculatory/seminal fluid production. | Hormonal disorders can impair sperm production, semen volume, or quality. Medical or hormone therapy may help. (Source: PubMed). |
| Varicocele | Abnormal dilation of veins in the scrotum (pampiniform plexus), often like varicose veins in the testicular region (Source: OUP Academic). | Varicoceles can impair testicular temperature regulation, oxygenation — reducing sperm quality, concentration, and may cause oxidative stress. Correcting a varicocele (e.g. microsurgical varicocelectomy) has been shown in systematic reviews to improve sperm concentration and, in many cases, pregnancy rates for infertile couples. (Source: PubMed). |
Beyond these, urologists can also identify genetic or anatomical abnormalities, obstructive issues (e.g. congenital absence of vas deferens), or other systemic health factors that impact fertility (Source: AUA Network).
Urologist as Part of a Multidisciplinary Fertility Care Team
Because male-factor infertility is complex and often multifactorial, reproductive urologists are key members of a multidisciplinary fertility team — alongside reproductive endocrinologists or fertility specialists, lab technicians, and counsellors. Their role includes:
Performing specialized diagnostic evaluations (history, physical exam, semen analyses, hormonal testing, imaging, genetic testing when indicated) according to clinical‑guideline standards (Soirce: AUA Network).
Offering medical, surgical, or microsurgical treatments when indicated: from hormonal therapy to microsurgical varicocelectomy, sperm retrieval (for azoospermia or ejaculatory issues), or correcting ejaculatory duct obstruction. (Source: MDPI).
Advising on lifestyle and environmental factors that affect male reproductive health, such as obesity, smoking, toxin exposure, heat, and overall health — factors which research increasingly links to sperm quality and fertility outcomes (Source: PMC).
Helping plan fertility strategies tailored to the couple — deciding when less invasive interventions can work, or when ART (IUI, IVF, ICSI) is appropriate, maximizing both success and cost-effectiveness (Source: PMC).
A recent 2024 narrative review on male reproductive health underscores ongoing challenges — declining sperm quality worldwide, rising lifestyle-related risk factors, and the need for male‑centered fertility care. (Source: World Journal of Men's Health).
Overall Reproductive Health & Why Early Urologist Involvement Matters
Male fertility isn’t only about the ability to conceive. Poor sperm parameters or ejaculatory disorders may also be early markers of broader health issues — hormonal disorders, metabolic syndrome, varicocele‑related testicular damage, or other urological conditions. A comprehensive male evaluation can:
- Identify and treat reversible causes before fertility interventions are needed.
- Improve overall health and reduce long-term risks (hormonal, vascular, testicular health).
- Avoid unnecessary or overly aggressive fertility treatments if simpler medical or surgical solutions exist.
- Provide couples with realistic, evidence-based fertility plans; ensure both partners are appropriately evaluated.
Moreover, studies show that when a reproductive urologist is involved early — even before ART — this collaborative approach not only improves fertility outcomes but also serves as an opportunity to screen for and manage broader male health risks.
Source: PMC
Why Your Clinic Should Include a Reproductive Urologist
Given the frequency and variety of male-factor fertility issues — and their potential treatability — a reproductive urologist is an essential member of any comprehensive fertility care team. From diagnosing low sperm count or ejaculatory dysfunction, to correcting varicoceles or managing hormonal imbalances, a urologist’s expertise helps address the root of many fertility challenges.
For patients and couples: seeing a urologist early — not just after repeated failed fertility attempts — can save time, reduce emotional and financial burden, and increase the likelihood of success.
Treatment Options Provided by a Urologist
Reproductive urologists specialize in diagnosing and treating male infertility and reproductive health issues. Their treatments span lifestyle, medical, and surgical interventions, often integrated with assisted reproductive technologies (ART) like in vitro fertilization (IVF) and ICSI. Below is a detailed overview of the common treatment approaches:
1. Lifestyle and Medical Management
Lifestyle modifications and medical therapy are often the first-line interventions for improving male fertility and overall reproductive health.
Lifestyle interventions: These include maintaining a healthy weight, regular exercise, reducing alcohol intake, quitting smoking, limiting exposure to environmental toxins, and optimizing diet and sleep. Evidence shows that lifestyle factors significantly influence sperm quality, motility, and DNA integrity (Source: PMC).
Supplements and nutraceuticals: Certain vitamins and antioxidants (e.g., vitamin C, vitamin E, zinc, CoQ10, folate) may improve sperm quality and reduce oxidative stress, though evidence varies and supplements should be personalized by a urologist (Source: PubMD).
Hormonal therapy: In men with endocrine abnormalities (hypogonadism, low testosterone, or pituitary hormone dysfunction), hormonal therapy may restore sperm production and improve fertility potential. This is especially important when sperm count is low due to hormonal imbalance (Source: PubMD).
2. Surgical Procedures
Surgical interventions are offered when anatomical, obstructive, or structural issues contribute to infertility. Common procedures include:
Varicocelectomy:
Definition: Microsurgical repair of dilated scrotal veins (varicocele) that impair testicular function.
Purpose: Improves testicular function through improved temperature regulation and oxygenation, often leading to improved sperm concentration, motility, and morphology in men with clinical (palpable) varicocele and abnormal semen parameters.
Evidence: Systematic reviews show varicocelectomy significantly improves semen parameters and may increase natural pregnancy rates in appropriately selected infertile men with clinical varicocele (Source: PubMD).
Vasectomy Reversal:
Definition: Microsurgical reconnection of the vas deferens after a vasectomy.
Purpose: Restores sperm flow for men who desire fertility after prior sterilization.
Success Rates: Dependent on time since vasectomy, surgical technique utilized, and female partner fertility factors; microsurgical techniques may be an option for reproduction after vasectomy. Specific needs and characteristics of each couple should be considered and discussed to determine success rates (Source: PubMD).
Sperm Retrieval Techniques:
Used when sperm are absent in ejaculate (azoospermia) or cannot be collected naturally:
TESA (Testicular Sperm Aspiration): Needle aspiration of sperm from the testicle.
TESE (Testicular Sperm Extraction): Surgical biopsy to extract sperm from testicular tissue.
Micro-TESE (Microsurgical TESE): Highly precise extraction under an operating microscope, often used for men with non-obstructive azoospermia.
Clinical Note: Retrieved sperm can be used in ICSI cycles for IVF, allowing couples to conceive even in severe male-factor infertility (Source: MDPI).
Medications for Erectile Dysfunction (ED) or Ejaculatory Dysfunction:
Definition: Pharmacologic agents (e.g., PDE5 inhibitors) or medical strategies to improve erectile function or ejaculation.
Purpose: Ensures sperm can reach the female reproductive tract; sometimes combined with sperm retrieval if ejaculation is not possible (Source: AUA Guideline).
3. Coordination with IVF / ICSI Cycles
Reproductive urologists often collaborate directly with fertility clinics to optimize assisted reproductive technology (ART) outcomes:
- Provide sperm samples for IUI, IVF, or ICSI when natural conception is not possible.
- Retrieve sperm surgically (TESA/TESE/micro-TESE) for immediate use in ART cycles.
- Ensure any underlying male-factor issues are addressed before initiating ART, which can improve success rates, reduce unnecessary interventions, and lower costs (Source: PMC).
A reproductive urologist’s role is comprehensive: they combine lifestyle guidance, medical therapy, and advanced surgical procedures to optimize male fertility. Early involvement in a fertility plan ensures that reversible or treatable causes of male infertility are addressed, maximizes natural and assisted conception chances, and improves overall reproductive health.
When should men see a fertility-focused urologist?
Medical-journal evidence and guideline-based recommendations agree that men should see a fertility specialist in the following situations:
You and your partner have been trying to conceive for 12 months without pregnancy or 6 months if the female partner is 35 or older.) This meets the clinical definition of infertility (Source: ASRM), and a full male fertility evaluation is recommended — not just a semen analysis.
You had an abnormal semen analysis. If any of the following were flagged:
- Low sperm count
- Low motility (movement)
- Abnormal morphology
- Low semen volume
- No sperm seen (azoospermia)
A reproductive urologist should perform a complete evaluation. The Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I states that abnormal semen parameters require medical review, not just repeat testing (Source: ASRM).
You have risk factors that affect male fertility. These may include:
- History of undescended testicles
- Prior testicular surgery or trauma
- Known varicocele
- Exposure to certain medications, heat, toxins, or testosterone supplements
- History of chemotherapy or radiation
- Diabetes, hormonal disorders, or chronic illness
History of chemotherapy, trauma, surgery, or infections
- Chemotherapy can damage testicular tissue and reduce sperm production, sometimes permanently.
- Trauma to the testes, penis, or reproductive tract can affect sperm production or delivery.
- Prior surgeries, such as hernia repair or pelvic procedures, may accidentally impact sperm transport.
- Infections, particularly mumps orchitis or sexually transmitted infections, can cause testicular inflammation and impair fertility.
Men with these histories may have subtle or delayed reproductive consequences that aren’t obvious without testing. A urologist can evaluate sperm production, check for blockages, assess hormone levels, and discuss fertility preservation options if necessary. Early evaluation ensures interventions are timely, which may improve fertility outcomes and prevent unnecessary ART procedures.
References:
- Agarwal A, et al. Male infertility. Lancet. 2021;397:319‑333 (pubmed.ncbi.nlm.nih.gov)
- American Urological Association (AUA) Male Infertility Guidelines (auanet.org)
You’re planning fertility treatment (IUI, IVF, or ICSI) and a sole or contributing male factor has been identified. A reproductive urologist can determine whether:
- There is a treatable cause
- Sperm quality can be improved before treatment, or
- Surgery (such as varicocele repair) could increase the chance of natural or assisted conception.
Evidence shows that addressing male-factor causes upfront can improve ART success rates and may reduce treatment costs.
Prior vasectomy. A vasectomy is a surgical procedure that blocks the vas deferens, preventing sperm from entering the ejaculate. Many men later decide to pursue fertility, either naturally (via reversal) or with ART.
Even years after a vasectomy, sperm can sometimes be successfully restored via vasectomy reversal or retrieved surgically for IVF/ICSI. A urologist evaluates:
- Whether reversal is possible
- The likelihood of natural conception
- Need for surgical sperm retrieval (TESA, TESE, or micro-TESE)
- Coordination with fertility specialists for ART
Reference:
- Belker AM, et al. Vasectomy reversal: a 10-year experience. J Urol. 1991;145:505–510. (pubmed.ncbi.nlm.nih.gov)
What to Expect at a Male Fertility Assessment Appointment
A reproductive urologist will typically perform the following, but is not limited to:
- A detailed medical and reproductive history
- Physical examination focused on testicular and genital anatomy
- Review of semen analysis results
- Hormone testing if needed (FSH, LH, testosterone, prolactin)
- Scrotal ultrasound if indicated
- Genetic testing for certain types of azoospermia
- Discussion of lifestyle factors, medications, supplements, or exposures
- A treatment plan tailored to your situation
Many causes of male infertility are treatable, and early intervention often leads to better outcomes.
Why Seeing a Male Fertility Specialist Matters
A reproductive urologist can help uncover specific male issues and provide a comprehensive evaluation. According to clinical studies:
- Up to 50% of male infertility causes are identifiable and treatable
- Addressing male-factor issues early can improve natural conception rates
- Semen abnormalities can be markers of broader health risks, making evaluation important beyond fertility
This isn’t just about sperm — it’s about overall health.
Need Help? We Recommend Early Evaluation
If you’re on a fertility journey, including a male fertility specialist early can save time, reduce stress, and create a clearer path forward. A reproductive urologist provides answers, direction, and evidence-based care tailored to your unique situation.
Key Takeaways
Yes — in Ontario, referrals and OHIP coverage usually apply to urologist visits and consultations.
Sperm retrieval is generally manageable in terms of pain and recovery, with high satisfaction rates.
Andrologists are urologists specialized in male reproductive health — ideal for fertility evaluation and treatment.
Even post-vasectomy, fertility options remain: via reversal or sperm retrieval.
Normal semen analysis is good — but a full urologic evaluation may still be valuable, especially if planning for future fertility, ART, or if any risk factors exist.
Urologist in Ontario FAQs
Yes — for OHIP‑covered care. In Ontario, most specialist visits (including urologists) typically require a referral.
For publicly funded care under OHIP, obtain a referral from a family doctor or NP first.