Should I be concerned about my fertility with a low sperm count, poor morphology, and borderline Follicle-Stimulating Hormone (FSH) level?

Your Semen Parameters Are Reassuring Despite Borderline FSH

Based on your actual sperm count of 60 million/mL, 50% motility, and total motile count of 87 million, you have normal fertility potential and should not be overly concerned, despite your borderline elevated FSH of 10.9 IU/L. 1, 2

Understanding Your Results in Context

Your semen analysis places you well above subfertility thresholds:

• Sperm concentration of 60 million/mL far exceeds both the WHO lower reference limit of 16 million/mL 3 and the subfertility threshold of 13.5 million/mL 4
• Total motile count of 87 million is excellent and well above the 9 million threshold needed for intrauterine insemination 5
• 50% motility exceeds the 32% subfertility threshold and approaches the 63% fertile range 4
• 6% normal morphology falls in the indeterminate range (between 4-12% normal forms), which still allows for natural conception, though morphology is the single best predictor of fertility among semen parameters 4, 6, 7

What Your FSH Level Actually Means

Your FSH of 10.9 IU/L represents compensated hypospermatogenesis - a condition where your pituitary is working harder to maintain sperm production, but is successfully doing so 5:

• FSH >7.6 IU/L indicates some degree of testicular stress, but your actual sperm output demonstrates the compensation is working 1, 2
• Your normal LH of 7.1 IU/L and adequate testosterone of 36 nmol/L indicate your Leydig cells are functioning well, which typically correlates with preserved spermatogenesis 1, 2
• Your testicular volumes of 13 mL and 12 mL are at the lower end of normal (normal range 15-25 mL), which explains the elevated FSH but doesn't preclude fertility 1

The Critical Caveat: You Are at Risk for Decline

Men with elevated FSH and currently normal semen parameters are significantly more likely to experience declining sperm counts over time compared to men with normal FSH 5:

• In a study of 858 men, those with FSH ≥7.6 IU/L were more likely to develop oligospermia (<15 million/mL) at follow-up compared to men with normal FSH 5
• Men with elevated FSH were more likely to see their total motile count drop below 9 million over time 5
• This represents an at-risk population requiring close monitoring 5

What You Should Do Now

Immediate Actions

• Consider sperm cryopreservation if you plan to delay fatherhood, as your parameters may decline over time 1, 5
• Collect 2-3 ejaculates for banking if possible, as this provides backup samples 1
• Never use testosterone supplementation - it will completely suppress your sperm production through negative feedback and could cause azoospermia 1, 2, 3

Address Your High SHBG

Your high SHBG doesn't directly impair sperm production (which depends on intratesticular testosterone driven by LH, not circulating testosterone), but investigate reversible causes 1:

• Check thyroid function (TSH, free T4) - thyroid hormone directly increases SHBG production 1
• Evaluate for liver disease 1
• Review medications that may elevate SHBG 1

Optimize Reversible Factors

• Achieve optimal body weight if overweight (BMI >25) - weight loss can normalize gonadotropins 1, 2
• Optimize metabolic health and glycemic control 1, 2
• Avoid environmental toxins and occupational exposures 1
• Stop smoking if applicable 3

Monitoring Strategy

• Repeat semen analysis every 6-12 months to detect early decline 5
• Recheck FSH, LH, testosterone, and thyroid function after addressing reversible factors 1, 2
• If parameters decline to <15 million/mL concentration, consider genetic testing (karyotype and Y-chromosome microdeletion analysis) 1, 2

Treatment Options If Parameters Decline

If your sperm count drops below 15 million/mL or total motile count falls below 9 million:

• Assisted reproductive technology (IVF/ICSI) offers the highest pregnancy rates and should be discussed early, especially considering your female partner's age 1, 2
• FSH analogue treatment may modestly improve sperm concentration in idiopathic infertility, though benefits are limited compared to ART 1, 2, 8
• Aromatase inhibitors or selective estrogen receptor modulators have limited benefits that are outweighed by ART advantages 1, 2

Common Pitfalls to Avoid

• Don't be falsely reassured by your current normal parameters - the elevated FSH indicates you need ongoing monitoring 5
• Don't delay fertility plans unnecessarily - your testicular reserve is compromised and may decline further 1, 5
• Don't accept testosterone therapy from any provider if you want to preserve fertility - this is the single most important mistake to avoid 1, 2, 3
• Don't skip sperm banking if you're planning to wait years before attempting conception 1