What are my chances of conception in 2 years with a slightly low sperm count of 42 million/ml, FSH (Follicle-Stimulating Hormone) level of 9.9, LH (Luteinizing Hormone) level of 7.0, total testosterone level of 39.9, SHBG (Sex Hormone-Binding Globulin) level of 99, and testicle size of 13-15ml?

Your Fertility Prognosis with Current Parameters

With a sperm count of 42 million/mL, FSH 9.9, LH 7.0, total testosterone 39.9 (assuming ng/dL, which is low), SHBG 99, and testicular size 13-15mL, you have oligospermia with mild testicular dysfunction but retain good fertility potential for conception within 2 years, though the elevated SHBG and borderline FSH warrant investigation of reversible causes before attempting conception. 1, 2, 3

Understanding Your Current Status

Your sperm concentration of 42 million/mL exceeds the WHO lower reference limit of 20 million/mL for normal fertility, placing you in the oligospermic range rather than severely impaired. 1 However, this is below optimal levels and warrants attention given your 2-year timeline.

Your FSH of 9.9 IU/L is mildly elevated (normal upper limit approximately 7.6 IU/L), indicating the pituitary is working harder to stimulate sperm production, suggesting some degree of testicular resistance. 1, 2 This level is not severely elevated—men with non-obstructive azoospermia typically have FSH well above 12 IU/L—so your prognosis remains favorable. 2, 3

Your testicular size of 13-15mL is at the lower end of normal (normal range 15-25mL), which correlates with the mildly elevated FSH and suggests some degree of testicular dysfunction but not complete failure. 2

Critical Issue: Elevated SHBG

Your SHBG of 99 is significantly elevated (normal range approximately 10-57 nmol/L), which dramatically reduces your bioavailable testosterone even if total testosterone appears adequate. 2 This is a reversible factor that must be addressed:

• Check thyroid function immediately (TSH, free T4, free T3)—hyperthyroidism or excessive thyroid replacement directly increases SHBG production and disrupts the hypothalamic-pituitary-gonadal axis. 2
• Evaluate for liver disease—hepatic dysfunction can elevate SHBG. 2
• Assess metabolic factors—optimize diabetes control if present, as metabolic stress affects gonadotropin secretion. 2

Essential Next Steps Before Attempting Conception

1. Repeat Semen Analysis

Perform at least one more semen analysis 2-3 months apart to confirm parameters, as single analyses can be misleading due to natural variability. 1, 4 Ensure 2-3 days of abstinence before collection. 1

2. Complete Hormonal Workup

• Measure free testosterone or calculate free testosterone index using total testosterone and SHBG to determine actual bioavailable testosterone. 2
• Check prolactin—hyperprolactinemia can disrupt gonadotropin secretion. 1, 2
• Thyroid panel (TSH, free T4, free T3)—thyroid dysfunction commonly affects reproductive hormones and SHBG. 2

3. Physical Examination

Have a urologist assess for:

• Varicocele—present in 15-20% of infertile men; surgical correction can improve semen quality. 2, 4
• Testicular consistency—firm, normal consistency is reassuring versus atrophic changes. 1
• Vas deferens presence—to exclude congenital bilateral absence. 1

4. Genetic Testing (If Indicated)

Only pursue if repeat semen analysis shows sperm count dropping below 5 million/mL: 1, 2

• Karyotype analysis to exclude Klinefelter syndrome (47,XXY)
• Y-chromosome microdeletion testing (AZFa, AZFb, AZFc regions)

Your Fertility Timeline and Prognosis

Natural conception probability: Among couples with timed intercourse and optimal fertility, 38% conceive in cycle 1,68% by cycle 3,81% by cycle 6, and 92% by cycle 12. 5 Your parameters suggest you fall into the subfertile rather than infertile category, meaning conception may take longer but remains achievable.

With your current sperm count of 42 million/mL and mildly elevated FSH, natural conception within 2 years is realistic if:

• Female partner has normal fertility (age <35 preferred)
• Reversible factors (elevated SHBG, possible thyroid dysfunction) are corrected
• Timed intercourse is optimized
• No additional male or female factors are present

Treatment Considerations

What to AVOID

Never start exogenous testosterone therapy—this will completely suppress spermatogenesis through negative feedback on the hypothalamus and pituitary, potentially causing azoospermia that can take months to years to recover. 1, 2, 3, 4

Potentially Beneficial Interventions

• Correct thyroid dysfunction if present—this alone may normalize SHBG and improve spermatogenesis. 2
• Varicocele repair if palpable varicocele is found—can improve sperm parameters. 2, 4
• Lifestyle optimization—smoking cessation, weight normalization (BMI <25), improved diet (lower fat, more fruits/vegetables). 1, 4

Medical Therapy (Limited Benefit)

• FSH analogues may modestly improve sperm concentration in idiopathic oligospermia, though benefits are limited and FSH is not FDA-approved for this indication. 2, 3
• Selective estrogen receptor modulators (SERMs) like clomiphene have limited benefits that are outweighed by assisted reproductive technology. 2
• Aromatase inhibitors may improve spermatogenesis if estrogen is elevated, but evidence is limited. 2

Assisted Reproductive Technology

If natural conception does not occur within 12 months of optimized attempts, proceed directly to IVF/ICSI—this offers superior pregnancy rates compared to prolonged empiric hormonal therapy, especially given your 2-year timeline. 2 With your sperm count of 42 million/mL, IVF with or without ICSI should have excellent success rates.

Protective Measure

Consider sperm cryopreservation now as insurance, especially if follow-up semen analyses show declining trends. 2 This is particularly important given your mildly elevated FSH, which indicates some degree of testicular dysfunction that could potentially progress.

Common Pitfalls to Avoid

• Do not delay evaluation of elevated SHBG—this is likely reducing bioavailable testosterone and may be easily reversible (thyroid correction). 2
• Do not rely on single semen analysis—parameters vary significantly between samples. 1, 4
• Do not pursue prolonged empiric hormonal therapy—if natural conception fails after 12 months of optimized attempts, move to ART rather than spending months on treatments with limited evidence. 2
• Do not assume FSH of 9.9 means inevitable progression to azoospermia—this level indicates mild dysfunction, not testicular failure. 2, 3