Likelihood of Sperm Production with Your Hormone Profile
With an FSH of 10.6 IU/L and small testicular size, you are likely still producing some sperm, though probably at reduced levels consistent with oligospermia (low sperm count) rather than complete azoospermia. Your hormone pattern—mildly elevated FSH with normal LH (7.7) and adequate total testosterone (42 nmol/L, approximately 1211 ng/dL)—is the classic presentation of oligospermia, not primary testicular failure 1.
Understanding Your Hormone Profile
Your FSH level of 10.6 IU/L indicates mild testicular dysfunction, as FSH >7.6 IU/L suggests some degree of impaired spermatogenesis 1. However, this level is far below the threshold that predicts complete absence of sperm production 1.
Critical insight: Men with a solitary testis can maintain sperm production even with FSH levels as high as 54.6 mIU/ml, whereas men with bilateral testes typically become azoospermic above 25 mIU/ml 2. This demonstrates that FSH levels alone cannot definitively predict sperm presence or absence 1, 3.
Your normal LH (7.7 IU/L) argues strongly against primary testicular failure, which would show markedly elevated LH alongside elevated FSH 1. The combination of mildly elevated FSH with normal LH and adequate testosterone is characteristic of oligospermia, not azoospermia 1.
Impact of Small Testicular Size
Small testicular size correlates with reduced sperm production, but does not necessarily mean zero sperm 4. Research shows that testicular size has the strongest correlation with FSH levels and total sperm count, with both sperm quantity and quality becoming impaired in testes smaller than 14 ml 4.
However, small testicular size combined with your FSH level suggests reduced but not absent spermatogenesis 4, 5. Studies demonstrate that sperm production is dependent on testicular size, but even significantly reduced testicular volume can still support some degree of sperm production 5.
Your Elevated SHBG (90 nmol/L)
Your SHBG of 90 nmol/L is elevated and may be reducing your bioavailable testosterone, which could contribute to impaired spermatogenesis even though your total testosterone appears adequate 1. This is an important factor that warrants further evaluation, as the bioavailable testosterone fraction is what actually drives spermatogenesis 1.
Estimating Your Sperm Count
You cannot reliably estimate sperm count from hormone levels alone—a semen analysis is mandatory 1, 3. However, based on your hormone profile:
- Most likely scenario: Oligospermia with sperm concentration between 1-15 million/ml 6
- Less likely but possible: Severe oligospermia with sperm concentration <1 million/ml 7
- Unlikely: Complete azoospermia, given your normal LH and adequate testosterone 1
Research shows that men with FSH levels >7.5 IU/L have a five- to thirteen-fold higher risk of abnormal sperm concentration compared to men with FSH <2.8 IU/L, but this indicates reduced counts, not necessarily zero 6.
Essential Next Steps
You must obtain at least two semen analyses separated by 2-3 months to determine your actual sperm count 1, 3. Single analyses are insufficient due to natural variability in sperm production 1.
If semen analysis confirms severe oligospermia (<5 million/ml) or azoospermia:
- Karyotype analysis is recommended to exclude chromosomal abnormalities like Klinefelter syndrome 7
- Y-chromosome microdeletion testing (AZFa, AZFb, AZFc regions) is mandatory if sperm concentration is <1 million/ml 7
Critical Pitfalls to Avoid
Never start exogenous testosterone therapy if you desire fertility—it will completely suppress FSH and LH through negative feedback, potentially causing azoospermia that can take months to years to recover 1, 3.
Your elevated SHBG should be investigated, as conditions causing elevated SHBG (thyroid dysfunction, metabolic issues) may be reversible contributors to your reduced sperm production 1.
FSH levels can fluctuate, so repeat hormonal testing after addressing any reversible factors is warranted 1.
Treatment Considerations if Oligospermia is Confirmed
If semen analysis confirms oligospermia, assisted reproductive technology (IVF/ICSI) offers the highest pregnancy rates and should be discussed early, particularly considering your female partner's age 1, 3.
FSH analogue treatment may modestly improve sperm concentration in idiopathic oligospermia, though benefits are limited compared to ART 3, 8. Selective estrogen receptor modulators (SERMs) and aromatase inhibitors have been used off-label but have limited benefits that are outweighed by ART advantages 1, 3.
Human chorionic gonadotropin (hCG) injections are not indicated in your case, as your LH and testosterone are already adequate—hCG is reserved for hypogonadotropic hypogonadism 1.