Should You Freeze Sperm Now?
Yes, you should freeze sperm now—your parameters are currently excellent, but your elevated FSH (10.2 IU/L) and testicular atrophy (10 mL bilaterally) signal underlying testicular dysfunction that carries significant risk of progressive decline over the next 2 years before you plan to conceive. 1, 2
Your Current Fertility Status
Your semen analysis is reassuring:
- 87 million total motile sperm is well above the threshold for natural conception (WHO lower reference limit is 16 million/mL total concentration) 3
- 50% motility is adequate for both natural conception and assisted reproduction 4
- Testosterone of 36 nmol/L (approximately 1,038 ng/dL) is in the high-normal range 3
However, your FSH of 10.2 IU/L is elevated—research demonstrates that FSH >7.5 IU/L confers a five- to thirteen-fold higher risk of abnormal sperm concentration compared to men with FSH <2.8 IU/L 4. This indicates your pituitary is already compensating for reduced testicular function 2, 3.
The Critical Issue: Testicular Atrophy
Testicular volume of 10 mL bilaterally is below the normal threshold of 12 mL and represents testicular atrophy 1. This is not a benign finding:
- Testicular atrophy signals underlying testicular dysfunction and reduced spermatogenic capacity 1, 2
- FSH levels are negatively correlated with spermatogonia numbers—higher FSH indicates the pituitary is compensating for reduced testicular function, signaling progressive testicular failure 2, 3
- Men with testicular volume <12 mL and age <40 years have a ≥34% risk of harboring testicular intraepithelial neoplasia (TIN), which progresses to invasive cancer in 70% of cases within 7 years if untreated 1
Why You Should Freeze Now
1. Insurance Against Future Decline
The combination of elevated FSH and testicular atrophy indicates you are at high risk for progressive spermatogenic failure 1, 2. Once azoospermia develops, even microsurgical testicular sperm extraction (micro-TESE) only achieves 40-50% sperm retrieval rates 3. Your current excellent parameters may not persist for 2 years.
2. Sperm Banking Is Standard Practice for Your Profile
The American Society for Reproductive Medicine recommends that men with elevated FSH levels (>7.6 IU/L) freeze multiple sperm samples while parameters are still normal, as this provides insurance against future decline 2. The 2025 ASCO guidelines emphasize that sperm cryopreservation is the most effective method of fertility preservation in postpubertal males 5.
3. Current Parameters Are Ideal for Banking
Your 87 million total motile sperm will tolerate the freeze-thaw process well. While sperm concentration and progressive motility decrease significantly after cryopreservation, even limited sperm after thawing can achieve fertilization through intracytoplasmic sperm injection (ICSI) 5, 1. With your current excellent parameters, post-thaw quality will remain adequate for ICSI 1.
Recommended Action Plan
Immediate Steps:
- Collect at least 2-3 ejaculate samples over several days (separated by 2-7 days), with each collection aliquoted to obtain >5 million total motile sperm per sample 5, 1, 2
- Bank sperm immediately before any diagnostic or therapeutic intervention, as recommended by the European Association of Urology 1
- Cost is approximately $1,500 for three samples stored for 3 years, with annual storage fees thereafter 1
Essential Medical Evaluation:
You need urgent evaluation for occult testicular malignancy:
- Perform hormonal evaluation: total testosterone, LH, and FSH 1
- Consider contralateral testicular biopsy to detect TIN, particularly given your age <40 and testicular volume <12 mL 1
- The atrophic testis may already contain undiagnosed germ cell malignancy or represent a "burned out tumor" with only scar tissue remaining 1
Monitoring Protocol:
- Repeat semen analysis every 6-12 months to monitor for decline, as changes in semen parameters take time to manifest and may not be apparent on a single analysis 2, 3
- Recheck FSH, LH, and testosterone every 6-12 months 2
- Evaluation by a male reproductive specialist for testicular consistency, presence of varicocele, and vas deferens/epididymal abnormalities is recommended given borderline testicular volume 3
Addressing Your Specific Concerns
"What if my baseline FSH has always been high?"
This makes banking even more urgent. If your FSH has been chronically elevated, this indicates longstanding testicular dysfunction rather than a temporary fluctuation 2, 3. The risk of progressive decline is higher, not lower.
"Will my body maintain good sperm output?"
The honest answer is uncertain, but the risk is substantial. Men with your profile (elevated FSH + testicular atrophy) are at high risk for progressive spermatogenic failure 1, 2. While you may maintain adequate counts, banking now eliminates the risk of losing your fertility window entirely.
Critical Pitfalls to Avoid
Never start exogenous testosterone therapy if fertility is desired—it will completely suppress spermatogenesis through negative feedback, potentially causing azoospermia that takes months to years to recover 5, 1, 2
Do not delay banking for "one more test"—your current parameters are excellent for banking. If you wait and parameters decline, you may miss the optimal window 1, 2
Do not ignore the testicular atrophy—this requires evaluation for occult malignancy, not just fertility monitoring 1
Bottom Line
Your current sperm count is excellent, but the underlying testicular dysfunction (elevated FSH + atrophy) creates substantial risk of decline over the next 2 years. Banking now costs approximately $1,500 and provides complete insurance against future fertility loss 1. Given the 2-year timeline before attempting conception, the risk-benefit calculation strongly favors banking immediately 1, 2. Only 9% of cryopreserved samples are eventually used, but for those who need them, they represent the difference between biological fatherhood and donor sperm 1.