Likelihood of Sperm in Ejaculate with Your Hormone Levels
Based on your FSH of 10.5 IU/L, LH of 7.7, total testosterone of 40 nmol/L, and SHBG of 95, it is likely that you will have some sperm in your ejaculate, though possibly at reduced concentrations. Your FSH is moderately elevated but not in the range that strongly predicts complete absence of sperm, and your testosterone level is within normal range despite the elevated SHBG 1, 2.
Understanding Your Hormone Profile
Your FSH level of 10.5 IU/L indicates some degree of testicular stress but does not predict azoospermia (complete absence of sperm). FSH levels above 7.6 IU/L suggest some testicular dysfunction, but values need to exceed approximately 12 IU/L to have strong predictive value for severe subfertility 1, 2.
FSH is negatively correlated with sperm production—higher FSH generally indicates decreased spermatogenesis—but this correlation is not absolute. Men with FSH levels in your range (10-12 IU/L) can maintain fertility, and even men with significantly higher FSH can have retrievable sperm 1, 3.
Your testosterone level of 40 nmol/L (approximately 1150 ng/dL) is normal to high-normal, which is a favorable sign. The combination of borderline elevated FSH with normal testosterone suggests your Leydig cells (testosterone-producing cells) are functioning well, even if spermatogenesis is somewhat impaired 2, 4.
Your elevated SHBG of 95 reduces free testosterone availability, but your total testosterone is high enough to compensate. The testosterone-to-FSH ratio remains reasonable, which is associated with better semen parameters 2.
What This Means Clinically
Men with FSH levels >7.6 IU/L but <12 IU/L typically have oligospermia (low sperm count) rather than azoospermia (no sperm). Complete absence of sperm is more strongly associated with FSH levels well above 12 IU/L, particularly when accompanied by testicular atrophy 1, 3.
The risk of abnormal semen parameters increases with FSH above 4.5 IU/L, with a dose-response relationship. Men with FSH >7.5 IU/L have 5-13 times higher risk of abnormal sperm concentration and morphology compared to men with FSH <2.8 IU/L, but this does not mean complete absence of sperm 2.
Even in non-obstructive azoospermia (where FSH is typically much higher than yours), up to 50% of men have retrievable sperm with testicular sperm extraction. Your FSH level suggests you are more likely to have ejaculated sperm than these men 1, 3.
Essential Next Steps
Obtain a complete semen analysis—this is the only way to definitively determine if sperm are present and in what quantity. The analysis should include sperm concentration, total sperm number, motility, and morphology assessment 5, 1.
If sperm concentration is found to be less than 5 million/mL, genetic testing including karyotype and Y-chromosome microdeletion analysis should be performed. This is particularly important before considering assisted reproductive technologies 5.
Physical examination focusing on testicular size and consistency would provide additional diagnostic information. Normal-sized testes with your FSH level suggest better prognosis than atrophic testes 1, 6.
Critical Warnings
Absolutely avoid testosterone supplementation if you are concerned about fertility. Exogenous testosterone suppresses FSH and LH through negative feedback, which will further impair or completely shut down spermatogenesis, potentially causing azoospermia 5, 1.
FSH alone cannot definitively predict fertility status—men with maturation arrest can have normal FSH despite severe spermatogenic dysfunction, and conversely, men with elevated FSH can maintain fertility. This is why semen analysis is essential 1, 3.
Your elevated SHBG may be affecting free testosterone availability for spermatogenesis. Lifestyle factors including diet, body composition, and certain medications can influence SHBG levels 1.
Treatment Considerations If Needed
If semen analysis reveals oligospermia, selective estrogen receptor modulators (SERMs) or aromatase inhibitors may be considered to optimize hormonal balance, though benefits are limited compared to assisted reproductive technologies. These work by reducing negative feedback and potentially increasing FSH and LH 5, 6.
For idiopathic infertility with low sperm count, FSH analogues may improve sperm concentration, pregnancy rate, and live birth rate. However, this would only be considered after confirming reduced sperm count on semen analysis 6.
If severe oligospermia or azoospermia is confirmed, intracytoplasmic sperm injection (ICSI) with or without testicular sperm extraction remains the most effective treatment approach. Given your hormone profile, the likelihood of finding usable sperm is reasonable 5, 4.