With elevated Follicle-Stimulating Hormone (FSH) levels and small testicle size, am I still producing sperm?

Likelihood of Sperm Production with Your Hormone Profile

Yes, you are almost certainly still producing some sperm despite your FSH of 10 IU/L and small testicular size, though likely at reduced levels compared to optimal fertility. 1, 2

Understanding Your Hormone Profile

Your FSH of 10 IU/L is mildly elevated but falls well below the threshold that indicates complete testicular failure. The key insight is that FSH levels alone cannot definitively predict whether you have sperm—up to 50% of men with non-obstructive azoospermia and elevated FSH still have retrievable sperm. 1

• FSH >7.6 IU/L suggests some degree of testicular dysfunction, but this does not mean complete absence of sperm production 1, 3
• Your LH of 7.7 IU/L is normal, which argues against primary testicular failure—if your testes were completely failing, LH would typically be much more elevated 1
• Your testosterone of 40 nmol/L (approximately 1154 ng/dL) is in the high-normal to elevated range, making complete testicular failure very unlikely 1
• This hormone pattern (mildly elevated FSH with normal LH and adequate testosterone) is the classic presentation of oligospermia (low sperm count), not azoospermia (complete absence of sperm) 1

What Your Small Testicular Size Means

Small testicular size combined with elevated FSH typically indicates impaired spermatogenesis, but preserved testicular volume (even if reduced) suggests maintained spermatogenesis rather than complete testicular failure. 1

• Testicular size correlates strongly with sperm production—smaller testes produce fewer sperm, but rarely zero sperm unless severely atrophic 4, 5
• Men with non-obstructive azoospermia typically present with testicular atrophy AND much higher FSH levels (often >15-20 IU/L) 1, 5
• FSH levels are negatively correlated with the number of spermatogonia (sperm-producing cells), meaning higher FSH indicates decreased but not necessarily absent sperm production 1, 2

Critical Next Steps

You must obtain a semen analysis—this is the only way to determine your actual sperm count. 1, 2, 3 Hormone levels provide clues but cannot definitively predict fertility status.

• Perform at least two semen analyses separated by 2-3 months, as single analyses can be misleading due to natural variability 1, 2
• If semen analysis confirms severe oligospermia (very low count) or azoospermia, obtain karyotype analysis and Y-chromosome microdeletion testing (AZFa, AZFb, AZFc regions) 1, 2
• Measure SHBG (sex hormone binding globulin) to calculate free testosterone, as high SHBG can reduce bioavailable testosterone and impair spermatogenesis 1
• Check thyroid function (TSH, free T4) as thyroid disorders commonly affect reproductive hormones and are reversible 1
• Check prolactin to exclude hyperprolactinemia, which can disrupt gonadotropin secretion 1

Important Caveats and Pitfalls

Never start testosterone supplementation if you desire fertility—it will completely suppress sperm production through negative feedback on your pituitary gland, potentially causing complete azoospermia that can take months to years to recover. 1, 2, 3

• Men with maturation arrest on testicular histology can have normal FSH and testicular volume despite severe spermatogenic dysfunction, so FSH alone is an imperfect predictor 1, 2
• Research shows that FSH levels >4.5 IU/L are associated with abnormal semen parameters, particularly sperm concentration and morphology 6
• Your FSH of 10 IU/L places you at increased risk for abnormal semen quality, but this does not equate to zero sperm 6

Treatment Considerations If Needed

If semen analysis confirms oligospermia:

• Assisted reproductive technology (IVF/ICSI) offers the highest pregnancy rates and should be discussed early, especially considering your female partner's age 1, 2
• FSH analogue treatment may modestly improve sperm concentration in men with idiopathic infertility, though benefits are limited 2, 7
• Selective estrogen receptor modulators (SERMs) and aromatase inhibitors have been used off-label with limited benefits that are outweighed by ART advantages 1, 2
• Address potentially reversible causes such as thyroid dysfunction, metabolic optimization, and weight normalization 1

If semen analysis confirms azoospermia:

• Microdissection testicular sperm extraction (mTESE) successfully retrieves sperm in approximately 50% of non-obstructive azoospermia cases, even with elevated FSH 1
• Complete AZFa and AZFb Y-chromosome deletions have almost zero likelihood of sperm retrieval and would contraindicate surgical sperm extraction 1