Assessment of Your Fertility Status
Based on your hormone levels, testicular volume, and semen analysis, you do NOT have testicular atrophy, and your current fertility parameters are reassuring—your 87 million total motile sperm count is well above the threshold for normal fertility, and your body is likely to maintain adequate sperm production for conception in 2 years. 1
Understanding Your Current Status
Your clinical picture does not fit the pattern of testicular atrophy or significant testicular dysfunction:
Your FSH of 10.2 IU/L is mildly elevated but falls well below the threshold that indicates primary testicular failure (typically FSH >35 IU/L would indicate severe dysfunction). 1
Your testicular volume of 10 mL bilaterally is at the lower end of normal but does not represent true atrophy. Research shows testicular volume is a reliable indicator of testicular function, and volumes below 10 mL are more concerning for significant dysfunction. 2
Your total motile sperm count of 87 million per ejaculate is excellent—this exceeds the normal reference limit of 39 million total sperm per ejaculate by more than double. 3
Your testosterone of 36 nmol/L (approximately 1038 ng/dL) is in the high-normal to elevated range, which argues strongly against primary testicular failure. 1
Your LH of 7.2 IU/L is normal, indicating your pituitary is not compensating excessively for testicular resistance. 1
What Your FSH Level Actually Means
The relationship between FSH and fertility is not absolute:
FSH levels are negatively correlated with sperm production, meaning higher FSH generally indicates the pituitary is working harder to stimulate the testes, but this does not mean sperm production has failed. 3, 4
FSH levels show natural variation among healthy men, and some individuals maintain FSH in the 10-12 IU/L range while maintaining normal fertility. 3
Research shows that FSH cutoffs around 2.9 IU/L predict abnormal total motile sperm count in adolescents with varicocele, but your total motile sperm count of 87 million is far above the abnormal threshold of <9 million. 5
Historical case reports document men with elevated FSH (similar to yours) who maintained normal sperm counts and fertility, representing "compensated primary testicular disease" where normal fertility is maintained despite mildly elevated FSH. 6
Addressing Your Concern About Testicular Size
Perceived changes in testicular size can be misleading:
Testicular volume of 10 mL bilaterally is at the lower limit of normal (normal range is typically 12-30 mL), but true atrophy is generally defined as volumes consistently below 10 mL. 2
Your excellent sperm parameters argue against significant testicular atrophy—if your testes were truly atrophying, you would expect to see declining sperm counts, not 87 million total motile sperm. 2
Testicular volume correlates with spermatogenesis, and research shows that sperm count and motility decrease in accordance with testicular volume, but your sperm parameters are normal. 2
Likelihood of Maintaining Sperm Production
Your prognosis for maintaining fertility over the next 2 years is favorable:
Your current semen parameters are well within the normal range, with total motile sperm count exceeding normal thresholds by a significant margin. 3
Your hormone profile (normal LH, adequate testosterone, mildly elevated FSH) is the classic pattern seen in mild testicular dysfunction with maintained spermatogenesis, not progressive testicular failure. 1
Men with your hormone profile typically have oligospermia at worst, not azoospermia, and your sperm count is already normal. 1
Essential Monitoring and Protective Actions
To ensure you maintain fertility for conception in 2 years:
Repeat semen analysis in 6-12 months to establish whether your sperm parameters are stable or declining, as single analyses can be misleading due to natural variability. 1
Consider sperm cryopreservation now as insurance, especially given your concern about declining testicular size—this provides backup samples if parameters worsen. 1
Avoid testosterone supplementation or anabolic steroids, as these will completely suppress spermatogenesis through negative feedback and can cause azoospermia that takes months to years to recover. 1, 3
Optimize lifestyle factors: avoid smoking, maintain healthy weight, minimize alcohol consumption, and avoid environmental toxins (pesticides, heavy metals), as these are associated with reduced fertility. 7
Physical examination by a urologist to assess for varicocele (dilated veins in the scrotum), as correction of palpable varicoceles improves both semen quality and fertility. 7, 1
Important Caveats
FSH levels alone cannot definitively predict fertility status—up to 50% of men with non-obstructive azoospermia and elevated FSH still have retrievable sperm, and you already have excellent sperm counts. 1, 3
Age 30 is not associated with significant fertility decline in men—male fertility decreases gradually with age, but 30 is well within the optimal reproductive years. 7
If follow-up semen analysis shows declining trend (sperm concentration dropping below 16 million/mL or total motile sperm count below 20 million), then genetic testing (karyotype and Y-chromosome microdeletion analysis) would be warranted. 1, 3
Your 50% motility is at the lower end of normal (normal progressive motility is typically >32%), so monitoring this parameter on repeat analysis is important. 1