What are the best fertility treatment options for a man with slightly low sperm motility and morphology, and a normal Follicle-Stimulating Hormone (FSH) level?

Fertility Treatment Approach for Mild Sperm Quality Abnormalities

With your sperm concentration of 60 million/mL (well above the 16 million/mL threshold), 45% motility (above the 32% subfertile threshold), and normal FSH, you have excellent natural conception potential and should pursue timed intercourse for 6-12 months before considering any medical interventions. 1, 2, 3

Understanding Your Current Fertility Status

Your semen parameters place you in a favorable position for natural conception:

• Sperm concentration: 60 million/mL significantly exceeds the WHO lower reference limit of 16 million/mL and falls well within the fertile range (>48 million/mL) 4, 3
• Total motile sperm count (TMSC): Approximately 27 million per ejaculate, which exceeds the 10 million threshold associated with good natural conception rates 2
• Motility at 45%: Above the 32% subfertile threshold, though below the optimal 63% fertile range 3
• Morphology at 5%: Below the 9% subfertile threshold but above the 4% critical cutoff 3
• FSH at 10.2 IU/L: Mildly elevated but within normal laboratory range, indicating some testicular stress but not primary testicular failure 1, 5

Critical Concern: Compensated Hypospermatogenesis

Your FSH level of 10.2 IU/L, while technically "normal," places you at risk for progressive decline in sperm parameters over time—a condition termed compensated hypospermatogenesis. 5

Men with FSH ≥7.6 IU/L and currently normal semen analysis are significantly more likely to develop oligospermia and declining total motile sperm counts compared to men with FSH <7.6 IU/L 5. This means your testicular reserve may be compromised despite adequate current sperm production.

Immediate Protective Actions

1. Sperm Cryopreservation (Strongly Recommended)

Consider banking sperm samples now as insurance against future decline. 4

• Collect 2-3 ejaculates for optimal preservation 4
• Men with elevated FSH and borderline parameters face high risk of progressive spermatogenic failure 4
• Once azoospermia develops, even microsurgical testicular sperm extraction only achieves 40-50% retrieval rates 4

2. Avoid Fertility-Damaging Exposures

Never use exogenous testosterone or anabolic steroids—these will cause complete suppression of sperm production that can take months to years to recover. 1, 4

Additional protective measures include:

• Complete smoking cessation (smoking impairs sperm concentration, motility, and morphology) 1
• Maintain healthy body weight and optimize diet (lower fat, more fruits and vegetables) 1
• Minimize heat exposure to testicles 4

Conception Strategy for the Next 5 Years

Year 1: Natural Conception Attempts

Pursue timed intercourse for 6-12 months without intervention, as your parameters support excellent natural conception probability. 2, 4

• Female partner age is the most critical factor—if she is under 30, you have >90% chance of pregnancy within 2-3 years 4
• Your TMSC of 27 million provides good natural conception rates 2

If No Conception After 12 Months: Assisted Reproductive Technology

IVF with ICSI offers superior pregnancy rates compared to any medical therapy and should be your next step if natural conception fails. 1, 2

• IUI with ovarian stimulation may be considered for 3 cycles if TMSC remains >10 million 2
• If IUI fails or TMSC declines below 10 million, proceed directly to IVF/ICSI 2
• ICSI directly overcomes motility and morphology defects 6, 2

Medical Interventions: Limited Role

Why Medical Treatments Are Not Recommended First-Line

Medical therapies for idiopathic male infertility have limited benefits that are outweighed by ART advantages, and may delay more effective treatment. 1, 6, 2

The evidence for medical interventions is weak:

• FSH analogues: May improve sperm concentration modestly, but benefits are limited compared to ART 1, 6, 7, 8
• SERMs and aromatase inhibitors: Limited benefits for men without documented low testosterone 1, 2
• Antioxidants and supplements: Questionable clinical utility with inadequate data 1

When Medical Treatment Might Be Considered

FSH analogue therapy (75-150 IU three times weekly) may be considered only if you strongly prefer to avoid ART, but expect modest improvements at best. 1, 7, 8

• One small study showed improved morphology in 3/14 patients who achieved pregnancy 7
• High-dose FSH (150 IU) showed significant improvements in concentration, motility, and morphology in another small study 8
• This represents conditional recommendation with Grade B-C evidence 1

Monitoring Protocol

Repeat Semen Analysis

Obtain repeat semen analysis every 3-6 months to detect declining trends early. 4, 5

• Single analyses are misleading due to natural variability 1, 4
• Men with elevated FSH are at higher risk for progressive decline 5

Hormonal Monitoring

Recheck FSH, LH, and testosterone every 6-12 months. 1

• Rising FSH suggests progressive testicular dysfunction 5
• If sperm concentration drops below 5 million/mL, obtain karyotype and Y-chromosome microdeletion testing 4

Physical Examination

Evaluation by a male reproductive specialist for varicocele, testicular consistency, and vas deferens abnormalities is warranted given your 10mL testicular volumes. 4

• Varicocelectomy may improve sperm parameters if clinical varicocele is present 6
• Men with abnormal semen parameters have higher rates of testicular cancer and increased mortality 4

Common Pitfalls to Avoid

1. Delaying conception attempts: With a 5-year timeline and mildly elevated FSH suggesting potential decline, start trying sooner rather than later 5

2. Pursuing prolonged medical therapy: Medical treatments delay more effective ART options without proven benefit for morbidity, mortality, or quality of life outcomes 1, 6

3. Ignoring female partner evaluation: Both partners require concurrent assessment, as couple infertility often involves multiple factors 2

4. Using testosterone for "low T": This will cause azoospermia and eliminate your fertility 1, 4

Bottom Line Algorithm

1. Bank sperm now as insurance against future decline 4
2. Try natural conception for 6-12 months with timed intercourse 2, 4
3. If no pregnancy after 12 months: Proceed to IUI (3 cycles maximum) or directly to IVF/ICSI 2
4. Monitor semen parameters every 3-6 months to detect decline early 4, 5
5. Avoid all testosterone products and anabolic steroids 1, 4