Will my body maintain good sperm output given my current hormone levels and semen analysis results?

Will Your Body Maintain Good Sperm Output?

Your current semen analysis shows excellent sperm production (87 million total motile sperm) that exceeds normal thresholds, but your FSH level of 10.2 IU/L indicates mild testicular stress that places you at risk for future decline in sperm parameters over the next 2 years. 1, 2

Understanding Your Current Status

Your hormone profile and semen analysis reveal a pattern called "compensated hypospermatogenesis"—your testes are working harder (elevated FSH) to maintain currently normal sperm output 2:

• FSH 10.2 IU/L: Mildly elevated, indicating your pituitary is compensating for some degree of testicular resistance 1, 3
• LH 7.2 IU/L: Normal, arguing against primary testicular failure 1
• Testosterone 36 nmol/L: Adequate for spermatogenesis 1
• Total motile sperm 87 million: Well above the normal threshold of 39 million 4
• 50% motility: Exceeds the normal reference limit of 42% 4
• Testicular volume 10 mL bilaterally: At the lower limit of normal (normal range typically 15-25 mL) 1

Risk of Future Decline

Men with your exact profile—elevated FSH with currently normal semen analysis—are significantly more likely to experience declining sperm parameters over time compared to men with normal FSH 2:

• Men with FSH ≥7.6 IU/L and normal initial semen analysis developed oligospermia (sperm concentration <15 million/mL) more frequently at each follow-up timepoint compared to men with normal FSH 2
• These men were more likely to experience decline in total motile sperm count below 9 million (the threshold for intrauterine insemination) 2
• The risk of developing multiple semen analysis abnormalities increased over time in this population 2

Your borderline testicular volume of 10 mL bilaterally is concerning, as testicular atrophy is characteristic of progressive testicular dysfunction 1. If your testicles have indeed decreased in size over the past year, this represents objective evidence of declining testicular reserve.

Critical Actions to Take Now

1. Repeat Semen Analysis in 3-6 Months

Perform at least one more semen analysis to establish whether your parameters are stable or declining 1, 5. Ensure proper collection technique:

• 2-3 days (ideally 4-5 days) of sexual abstinence before collection 6, 5
• Keep specimen at body temperature during transport if collected at home 6
• Examine within one hour of collection 6

2. Consider Sperm Cryopreservation Immediately

Given your elevated FSH, borderline testicular volume, and 2-year timeline, strongly consider banking sperm now as insurance 1:

• Once azoospermia develops, even microsurgical testicular sperm extraction only achieves 40-50% sperm retrieval rates 1
• Collect at least 2-3 ejaculates if possible to provide backup samples 1
• Sperm concentration and motility decrease after cryopreservation, but DNA integrity is preserved 1

3. Identify and Address Reversible Causes

Check for conditions that may be worsening your testicular function 1:

• Thyroid function (TSH, free T4): Thyroid disorders disrupt the hypothalamic-pituitary-gonadal axis and can elevate FSH 1
• Metabolic factors: Obesity (BMI >25), insulin resistance, and elevated SHBG can affect gonadotropin levels 1
• Varicocele: Physical examination by a reproductive urologist to assess for varicocele, which can progressively impair spermatogenesis 1
• Environmental exposures: Heat exposure, toxins, medications that may affect testicular function 6

4. Genetic Testing If Parameters Decline

If follow-up semen analysis shows sperm concentration dropping below 15 million/mL, obtain 1, 3:

• Karyotype analysis to exclude Klinefelter syndrome and chromosomal abnormalities
• Y-chromosome microdeletion testing (AZFa, AZFb, AZFc regions)

What NOT to Do

Never use exogenous testosterone or anabolic steroids if you want to preserve fertility 1, 3. Testosterone completely suppresses FSH and LH through negative feedback, eliminating intratesticular testosterone production and causing azoospermia that can take months to years to recover 1.

Treatment Options If Decline Occurs

If repeat semen analysis shows deterioration 1:

• Aromatase inhibitors or selective estrogen receptor modulators (SERMs): May modestly improve sperm parameters in men with elevated FSH, though benefits are limited 1
• Assisted reproductive technology (IVF/ICSI): Offers superior pregnancy rates compared to empiric hormonal therapy and should be discussed early given your 2-year timeline 1

Overall Health Implications

Men with low sperm counts have a 12-fold increased risk of hypogonadism and higher rates of metabolic syndrome, cardiovascular disease, and osteoporosis compared to men with normal sperm counts 7. Your fertility evaluation provides an opportunity for comprehensive health assessment and disease prevention 7.

Bottom Line

Your body is currently maintaining good sperm output, but the combination of elevated FSH and borderline testicular volume indicates you are at significant risk for decline over the next 2 years. The most prudent approach is to cryopreserve sperm now, repeat semen analysis in 3-6 months to monitor for decline, and address any reversible factors affecting testicular function. 1, 2