He should see a urologist, ideally one who specializes in reproduction, when the semen analysis comes back abnormal on two evaluations 4 to 12 weeks apart, or when there are specific risk factors such as an undescended testicle in childhood, mumps after puberty, a palpable varicocele or anabolic steroid use. If male factor is involved, this evaluation is essential.
Any one of the history items is reason enough for an evaluation, without waiting for a second semen analysis. The book counts several of them among the red flags that call for immediate evaluation, because they can have a significant impact on sperm production, and lists them among the reasons to see a specialist before the usual waiting time for trying has passed.
Persistent erectile or ejaculatory dysfunction: beyond the obvious impact on conception, it can point to hormonal or vascular problems that deserve evaluation.
Current or recent anabolic steroid use: it severely suppresses sperm production, and recovery takes 6 to 24 months after stopping.
When there is no specific risk factor, one abnormal result is not enough to send him to a specialist, because sperm production varies month to month. The path is:
For her, the usual entry point is a gynecologist with specialty training in reproductive medicine. For him, it is a urologist, ideally with specialty training in reproductive medicine. The book's phrasing is deliberate: it is the couple who needs to see the urologist. Half the equation is on him, and the decisions that follow involve both of you.
When the evaluation confirms a male factor, the book lists the treatment paths: treating reversible causes (varicocele, hormones), targeted supplementation and lifestyle changes; in more severe cases, assisted reproduction techniques (IUI, IVF, ICSI).
The book's summary on specialists says it plainly: your partner also needs specialized evaluation when indicated. And the chapter on his fertility makes the same point from the start: before you keep spending time and energy trying, he needs a semen analysis, and if the result stays abnormal, the next step is the urologist.
When to see a urologist closes Chapter 25 of Map to the Positive, "His fertility: what he needs to do", in Station III (Optimization). Station IV (Signs) then goes deeper: when to see a specialist for each age group, the full list of red flags for both of you and what the diagnoses mean. Together they help you decide when to keep optimizing and when to look for help.
Take 30 days. If it does not give you more clarity than everything you have read for free so far, ask for a refund and you get every cent back. We cannot promise you a pregnancy. We can promise you will not be guessing.
References: WHO laboratory manual for the examination and processing of human semen, 6th ed., 2021.