Should I be concerned about my fertility with an FSH (Follicle-Stimulating Hormone) level of 9.9, testicular size of 12ml and 10ml, sperm count of 52 million/ml, motility of 50%, and morphology of 6%?

Your Fertility Parameters Are Reassuring and Do Not Warrant Significant Concern

Based on current AUA/ASRM guidelines, your semen parameters are within normal ranges and your FSH level, while in the upper portion of normal, does not indicate testicular failure. Your sperm count of 52 million/ml exceeds the WHO lower reference limit of 16 million/ml by more than threefold, and your motility of 50% meets the minimum acceptable threshold for successful fertilization 1, 2.

Understanding Your Specific Parameters

FSH Level (9.9 IU/L)

• Your FSH of 9.9 IU/L falls within the normal laboratory range of 1-12.4 IU/L and is below the critical threshold of 12.1 IU/L that would suggest significant testicular dysfunction 3.
• The AUA/ASRM guidelines indicate that FSH levels greater than 7.6 IU/L suggest some degree of testicular dysfunction when accompanied by azoospermia or severe oligospermia, but this threshold does not apply to men with normal sperm counts like yours 1, 4.
• FSH levels show natural variation among healthy fertile men, and values in the 10-12 IU/L range can occur in men with completely normal fertility 3.

Testicular Volume (12ml and 10ml)

• Your testicular volumes are within the normal range, as testicular atrophy (a key indicator of primary testicular failure) typically presents with volumes well below 10ml 1, 4.
• Normal testicular size with FSH in the upper-normal range suggests preserved spermatogenic capacity rather than testicular failure 3, 4.

Sperm Parameters

• Sperm concentration of 52 million/ml: This exceeds the WHO reference limit of 16 million/ml by more than 3-fold, indicating excellent sperm production 1, 2.
• Motility of 50%: This meets the minimum acceptable threshold for fertility and is adequate for natural conception 2.
• Morphology of 6%: While this is in the borderline range (WHO reference is typically >4%), it is not severely abnormal and does not preclude natural conception 2.

Important Caveats and Monitoring

Natural Variability

• Semen parameters are highly variable biological measures and can fluctuate substantially between tests 1.
• The AUA/ASRM guidelines recommend at least 2 semen analyses obtained a month apart, especially if considering any interventions 1.

Lifestyle Optimization

• Avoid exogenous testosterone or anabolic steroids, which can cause complete suppression of spermatogenesis and lead to azoospermia 1, 4.
• Limit alcohol intake, avoid tobacco and illicit drugs, maintain a healthy weight if obese, and minimize exposure to environmental toxins like pesticides and heavy metals 1, 5.
• Reduce exposure to excessive heat (hot tubs, saunas, tight clothing) and occupational hazards that may affect sperm production 1.

When to Seek Further Evaluation

• If you and your partner have been trying to conceive for 12 months without success (or 6 months if female partner is over 35 years old), formal fertility evaluation is warranted 5, 6.
• If a repeat semen analysis shows declining sperm concentration approaching 20 million/ml or below, consider sperm cryopreservation and further hormonal evaluation including LH, testosterone, and thyroid function 3, 2.
• If sperm concentration ever drops below 5 million/ml with your current FSH level, genetic testing including karyotype and Y-chromosome microdeletion analysis would be indicated 1, 3.

What This Means for Your Fertility

Your current parameters suggest normal fertility potential for natural conception. The combination of normal-range FSH, preserved testicular volumes, and sperm parameters that exceed WHO reference limits indicates that your reproductive system is functioning adequately 1, 3, 2. The slightly elevated FSH in the context of normal sperm production likely represents normal biological variation rather than pathological testicular dysfunction 3.