Should I freeze sperm with an elevated Follicle-Stimulating Hormone (FSH) level, low sperm count, and impaired semen parameters?

Should You Freeze Sperm with Your Current Parameters?

Yes, you should freeze sperm immediately despite your currently adequate sperm count, because your testicular volumes (12ml and 9ml) combined with your FSH level (10.5 IU/L) indicate compromised testicular reserve with high risk of progressive spermatogenic failure. 1

Critical Risk Factor: Testicular Atrophy

Your smaller testis at 9ml represents significant testicular atrophy and creates two urgent concerns:

• Malignancy risk: Testicular volume <12ml in men under 40 years 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
• Progressive fertility decline: Men with testicular atrophy and elevated FSH are at high risk for progressive spermatogenic failure, and once azoospermia develops, even microsurgical sperm extraction only achieves 40-50% retrieval rates 1

Your Hormone Profile Indicates Testicular Dysfunction

Your FSH of 10.5 IU/L (upper normal range) combined with LH of 7 IU/L reveals:

• Compensatory pituitary response: Your pituitary is working harder to maintain sperm production, indicating the testes are not responding optimally to hormonal signals 1, 2
• FSH >7.6 IU/L threshold: This level carries a 5-13 fold higher risk of abnormal sperm concentration and suggests some degree of primary testicular dysfunction 2
• Progressive risk: While your current count of 60 million/ml is adequate, men with this hormone pattern and testicular atrophy face ongoing risk of deterioration 1

Why Freeze Now Despite Adequate Current Parameters

The window of opportunity may close:

• Once azoospermia develops, you lose the option of banking ejaculated sperm and must rely on surgical extraction with only 40-50% success rates 1
• Your current sperm count of 60 million/ml with 50% motility and 3ml volume (total motile count = 90 million) is excellent for cryopreservation and future assisted reproduction 3
• Sperm cryopreservation before any diagnostic intervention (such as testicular biopsy for TIN evaluation) is the standard recommendation 1

Recommended Clinical Algorithm

Immediate actions:

1. Bank sperm now - Collect at least 2-3 ejaculates if possible to maximize stored samples 3, 1
2. Urological evaluation - Given your 9ml testis, you need assessment for TIN, particularly if you're under 40 years old 1
3. Consider contralateral testicular biopsy to detect TIN, as this carries ≥34% risk with testicular volume <12ml 1

Important counseling points:

• If TIN is detected and treated with radiotherapy (20 Gy), your testis will become azoospermic, making banked sperm your only option for biological fatherhood 1
• Testicular atrophy is not benign - it signals either ongoing testicular damage or occult malignancy 1
• Your fertility potential may already be compromised and could worsen over time independent of any intervention 1

Cryopreservation Logistics

Practical considerations:

• Collect 2-3 samples separated by 2-7 days for optimal banking 3
• Cost is approximately $1,500 for three samples stored for 3 years, with annual storage fees thereafter 3
• Sperm concentration and motility decrease after thawing, but with your current parameters (60 million/ml, 50% motility), post-thaw quality will remain adequate for intracytoplasmic sperm injection (ICSI) 3, 4
• Even limited sperm after thawing can achieve fertilization through ICSI 3

Common Pitfalls to Avoid

Do not delay banking while "monitoring" your parameters:

• The risk with testicular atrophy is unpredictable progression - you cannot reliably predict when or if counts will drop 1
• Waiting for declining counts means you may bank lower quality sperm or miss the window entirely 1

Do not start testosterone therapy:

• Exogenous testosterone will completely suppress spermatogenesis through negative feedback, potentially causing azoospermia that takes months to years to recover 3, 2
• Your testosterone of 36 nmol/L is already adequate and does not require supplementation 2

Do not ignore the testicular atrophy:

• This requires urological evaluation for potential malignancy, not just fertility assessment 1
• The 9ml testis represents significant pathology that needs investigation 1

Bottom Line

Your situation differs from routine fertility preservation because testicular atrophy creates dual risks: progressive fertility decline and potential malignancy. Banking sperm now protects your fertility options before any diagnostic procedures or potential treatments that could eliminate sperm production entirely. 1 The cost and effort of banking are minimal compared to the irreversible loss of fertility if your counts decline or if TIN treatment becomes necessary. 3, 1