Should I freeze my sperm now given my current semen parameters and plans to try to conceive in 2 years?

Should You Freeze Your Sperm Now?

No, sperm freezing is not indicated in your case based on your current semen parameters, which show adequate sperm concentration (56 million/ml) and total motile count (86 million) for natural conception and assisted reproduction. 1, 2

Your Current Fertility Status

Your semen analysis demonstrates parameters well above the threshold for concern:

• Sperm concentration of 56 million/ml is more than adequate for both natural conception and any assisted reproductive technology (ART) that might be needed. 1
• Total motile count of 86 million far exceeds the minimum requirements for successful conception, even with assisted techniques. 1
• The guideline-based threshold for considering sperm freezing is when total sperm count falls below 1 million per ejaculate, or when at least one of two analyses shows counts below 1 million. 2

Evidence-Based Freezing Criteria

Research specifically addressing this question found that:

• Sperm freezing should only be performed when at least one total sperm count from two analyses is lower than 1 million (you have 56 million). 2
• When all sperm counts are ≥100,000 (0.1 million), the risk of azoospermia during an ICSI attempt is only 3%, compared to 52% when counts are below this threshold. 2
• Only 9% of cryopreserved sperm samples are eventually used in ART, while 23% are disposed of unused, highlighting the low utilization rate when freezing is done without clear indication. 1

The Exception: Testicular Atrophy Concern

Your testicular volumes (9.5ml and 12ml) warrant attention for a different reason:

• Testicular volume <12ml in men under age 40 carries a ≥34% risk of harboring testicular intraepithelial neoplasia (TIN), which progresses to invasive cancer in 70% of cases within 7 years if untreated. 1
• This is the primary concern with your presentation—not your current fertility status, but the risk of occult testicular malignancy. 1

Recommended Clinical Algorithm

Before considering fertility preservation, you need malignancy evaluation:

1. Obtain hormonal evaluation (you've already done this—your FSH 9.9, LH 7.5, and testosterone 42 nmol/L are within normal range). 1

2. Undergo imaging with transrectal ultrasound (TRUS) or pelvic MRI to evaluate for structural abnormalities, particularly given your low semen volume. 3

3. Consider testicular biopsy to detect TIN, especially given your testicular volume <12ml, as recommended by the European Association of Urology. 1

4. If TIN is detected and requires treatment with radiotherapy (20 Gy), the testis will become azoospermic—at that point, sperm banking before treatment becomes absolutely essential. 1

Cost-Benefit Analysis

• Sperm freezing costs approximately €70,000 in European healthcare systems when accounting for unnecessary procedures. 2
• The likelihood of needing frozen sperm with your current parameters is extremely low (estimated <5% based on your counts being well above critical thresholds). 2
• The freezing process itself causes damage to sperm genetic integrity and quality, resulting in decreased concentration and progressive motility after thawing. 1

What You Should Do Instead

Focus on the testicular atrophy workup first:

• Complete malignancy screening with imaging and consider biopsy if indicated. 1
• If malignancy is detected requiring gonadotoxic treatment (chemotherapy or radiotherapy), then immediately bank sperm before treatment initiation—this is when freezing becomes absolutely indicated. 4
• If no malignancy is found, proceed with attempting conception in 2 years without freezing, as your current parameters are adequate. 1, 2

Critical Pitfall to Avoid

Do not assume testicular atrophy is benign—it signals either ongoing testicular damage or occult malignancy and requires thorough evaluation before making fertility preservation decisions. 1