From the Guidelines
The FSH level of 9.8 IU/L suggests non-obstructive azoospermia, which is more likely the cause of infertility in this patient, given the FSH level is greater than 7.6 IU/L, as indicated in the 2024 AUA/ASRM guideline 1. This guideline provides updates to male infertility and defines various terms related to male infertility, including azoospermia, oligozoospermia, asthenozoospermia, teratozoospermia, and normozoospermia.
- The patient's FSH level is above the threshold of 7.6 IU/L, which is typically associated with non-obstructive azoospermia, characterized by spermatogenic failure.
- In contrast, obstructive azoospermia is suspected when FSH levels are usually less than approximately 7.6 IU/L, and the physical examination reveals testes of normal size, fully descended into the scrotum, and bilaterally dilated and/or indurated epididymides with or without absence of the vas deferens.
- The 2024 AUA/ASRM guideline also recommends karyotype testing for males with primary infertility and azoospermia or sperm concentration <5 million sperm/mL when accompanied by elevated FSH, testicular atrophy, or a diagnosis of impaired sperm production, as karyotype abnormalities are the most common known genetic abnormalities that cause male infertility 1. Given the patient's elevated FSH level, karyotype testing is recommended to rule out any underlying genetic abnormalities that may be contributing to the patient's infertility.
From the Research
Follicle Stimulating Hormone (FSH) Levels
- The provided FSH level is 9.8 IU/L, which is considered moderately elevated 2.
- Elevated FSH levels can predict low ovarian response, but should not be used to disqualify patients from attempting in vitro fertilization (IVF) 2.
- FSH has a primary function in procreation, inducing estrogen production in females and regulating spermatogenesis in males, but also has non-unitary functions, including regulating bone mass, adipose tissue function, energy metabolism, and cholesterol production 3.
Menopause and FSH
- Menopause is a major life event that can affect women in several ways, including a chronic hypo-estrogenic state, which can cause menopausal symptoms and impact bone and cardiovascular health 4, 5.
- FSH levels increase with age, and elevated FSH levels are often seen in menopausal women 3.
- Hormone replacement therapy (HRT) can be used to manage menopausal symptoms and may have benefits for bone health and cardiovascular health, but the risk-benefit ratio and safety profile of HRT differ by age and clinical characteristics 4, 5.
FSH and Ovarian Function
- Anti-Müllerian hormone (AMH) is a novel marker of ovarian function, reflecting the number of remaining ovarian follicles, and is negatively correlated with FSH in prepubertal girls 6.
- FSH levels can fluctuate during childhood and adolescence, but individual serum levels of AMH persist through childhood and adolescence, and a random AMH measurement seems representative for a given girl 6.
- Elevated basal FSH levels can predict low ovarian response, but should not be used to disqualify patients from attempting IVF, especially in young women 2.