Can You Still Produce Sperm with Slightly Small Testicles and FSH 10.5?
Yes, you should still be making sperm—an FSH of 10.5 IU/L with slightly small testicles suggests some degree of testicular dysfunction, but this level does not predict complete absence of sperm production, and many men in this range maintain fertility. 1, 2
Understanding Your FSH Level
Your FSH of 10.5 IU/L falls into a moderately elevated range that warrants attention but is not definitively abnormal:
- FSH levels show natural variation among healthy fertile men, with some maintaining levels in the 10-12 IU/L range throughout life while preserving normal fertility. 1, 2
- Higher FSH generally indicates decreased spermatogenesis due to negative feedback—when the testes produce fewer sperm, the pituitary releases more FSH to try to stimulate production. 1, 3
- FSH alone cannot definitively predict fertility status—the correlation between FSH and actual sperm production is imperfect, and men with FSH levels similar to yours frequently have retrievable sperm. 1, 2, 3
Clinical Significance of Your Presentation
The combination of slightly small testicles and FSH 10.5 suggests mild testicular dysfunction, but this does not equate to azoospermia (complete absence of sperm):
- FSH levels greater than 7.6 IU/L suggest some degree of testicular dysfunction, but values need to exceed approximately 12.1 IU/L (the 95th percentile) to have strong predictive value for severe subfertility. 1, 3
- Testicular size matters—smaller testes with elevated FSH indicate more significant impairment than normal-sized testes with the same FSH level, but even men with testicular atrophy and non-obstructive azoospermia have up to 50% chance of sperm retrieval. 1, 3
- Men with maturation arrest can have normal FSH and testicular volume despite severe spermatogenic dysfunction, demonstrating that the relationship is not straightforward. 1, 2, 3
Essential Next Steps
You need a semen analysis to determine if you are actually producing sperm—this is the only way to know your fertility status:
- Complete semen analysis with centrifugation is essential to confirm presence and quantity of sperm, including concentration (normal >16 million/mL), total count (normal >39 million per ejaculate), motility, and morphology. 1
- Additional hormonal evaluation including testosterone and LH would provide a more complete diagnostic picture of your hypothalamic-pituitary-gonadal axis function. 1, 3
- Physical examination focusing on testicular size and consistency by a urologist or reproductive endocrinologist would provide additional prognostic information. 1
If Semen Analysis Shows Problems
Should your semen analysis reveal oligospermia (low sperm count) or azoospermia:
- Genetic testing including karyotype and Y-chromosome microdeletion analysis is recommended if sperm concentration is less than 5 million/mL with your FSH level. 1, 3
- Aromatase inhibitors may improve spermatogenesis in select cases—one case report documented successful restoration of spermatogenesis in a man with non-obstructive azoospermia and elevated FSH using letrozole. 3, 4
- Microsurgical testicular sperm extraction (TESE) offers up to 50% success for sperm retrieval even in men with non-obstructive azoospermia and elevated FSH. 3
Critical Pitfalls to Avoid
- Never start testosterone supplementation if you desire fertility—exogenous testosterone suppresses FSH and LH through negative feedback, causing further suppression or complete cessation of spermatogenesis and can induce azoospermia. 1, 3
- Lifestyle factors including smoking, poor diet, and environmental exposures may temporarily affect your hypothalamic-pituitary-gonadal axis and FSH levels. 1, 2
- Do not assume infertility based on FSH alone—research shows that spermatogenesis can be maintained even with undetectable FSH levels in certain circumstances, demonstrating FSH is not absolutely required for all sperm production. 5