What are the next steps for a 30-year-old male with normal testicular size, elevated Follicle-Stimulating Hormone (FSH) levels, normal sperm count, concentration of 80 million per milliliter (mL), motility of 50%, and morphology of 6%, and a total motile count of 112 million, who is trying to conceive?

Evaluation and Management of Mild FSH Elevation with Normal Semen Parameters

Direct Recommendation

Your semen parameters are reassuring and indicate normal fertility potential—no immediate intervention is required, but you should undergo a focused evaluation to identify and address any reversible causes of the mildly elevated FSH, particularly thyroid dysfunction, metabolic factors, and lifestyle exposures. 1

Understanding Your Current Status

Your clinical picture is not consistent with non-obstructive azoospermia or significant testicular dysfunction:

• Normal testicular size (13 mL) argues strongly against primary testicular failure, as non-obstructive azoospermia typically presents with testicular atrophy and volumes well below normal 1, 2
• Sperm concentration of 80 million/mL far exceeds the WHO lower reference limit of 16 million/mL, indicating normal sperm production 1
• Total motile count of 112 million is excellent and well above thresholds for natural conception 3
• FSH of 10.2 IU/L is mildly elevated (above the 7.6 IU/L threshold) but does not indicate severe testicular dysfunction 1

The combination of mildly elevated FSH with normal testicular size and normal sperm parameters suggests mild compensated testicular function rather than primary testicular failure. 1

Essential Diagnostic Workup

Hormonal Evaluation

Measure the following to determine if this represents primary gonadal dysfunction versus a reversible cause: 1

• LH and total testosterone to assess whether the pituitary is compensating for testicular resistance 1
• Prolactin to exclude hyperprolactinemia, which can disrupt gonadotropin secretion 1
• TSH and free T4 to evaluate thyroid function, as thyroid disorders commonly affect reproductive hormones and can elevate FSH 1
• SHBG if not already measured, as elevated SHBG may reduce bioavailable testosterone 1

Repeat Semen Analysis

Obtain a second semen analysis in 3-6 months to establish whether parameters are stable or declining, as single analyses can be misleading due to natural variability 1, 3

Physical Examination by Specialist

Evaluation by a male reproductive specialist should assess: 1

• Testicular consistency and symmetry
• Presence of varicocele (palpable varicoceles can impair spermatogenesis and are correctable) 1
• Vas deferens and epididymal anatomy 2

Addressing Reversible Causes

Thyroid Optimization

Thyroid dysfunction can disrupt the hypothalamic-pituitary-gonadal axis and should be corrected if present, as even subtle thyroid abnormalities can elevate FSH and impair spermatogenesis 1

Metabolic Optimization

Weight normalization and metabolic optimization may improve hormonal parameters if BMI is elevated or metabolic syndrome is present 1

Lifestyle Modifications

Address modifiable factors that can affect spermatogenesis: 3

• Avoid excessive heat exposure to the testes
• Smoking cessation if applicable
• Limit alcohol intake
• Avoid illicit drug use
• Optimize diet with a profertility nutritional pattern 4

Critical Pitfalls to Avoid

Never Start Exogenous Testosterone

If fertility is desired now or in the future, never use exogenous testosterone therapy—it 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

FSH Levels Alone Cannot Predict Fertility

FSH of 10.2 IU/L does not preclude normal sperm production, as demonstrated by your normal semen parameters—up to 50% of men with non-obstructive azoospermia and much higher FSH levels still have retrievable sperm 1

Genetic Testing Not Currently Indicated

Karyotype analysis and Y-chromosome microdeletion testing are recommended only if sperm concentration is <5 million/mL, which does not apply to your case 1, 3, 2

Fertility Considerations

Natural Conception Potential

Your current semen parameters support excellent natural conception potential—the total motile count of 112 million far exceeds thresholds for unassisted pregnancy 1

Monitoring Strategy

If follow-up semen analyses show declining trends, consider sperm cryopreservation as a protective measure, particularly given the mildly elevated FSH suggesting some degree of testicular stress 1

Female Partner Evaluation

Concurrent evaluation of the female partner is essential, as comprehensive infertility management requires assessment of both partners 3, 4

Long-Term Health Implications

Men with abnormal semen parameters have higher rates of testicular cancer and increased mortality rates compared to fertile men—this evaluation is important for overall health screening beyond fertility concerns 1