Your Fertility Test Results: Implications and Recommendations
Overall Assessment
Your hormone levels and sperm parameters indicate you have normal fertility potential with adequate sperm production, though your FSH level of 10.2 IU/L suggests mild testicular stress that warrants attention to your thyroid management and diabetes control. 1, 2
Your sperm count of 56 million/ml with 60% motility significantly exceeds the World Health Organization lower reference limit of 16 million/ml and represents normal fertility parameters. 1 However, the combination of borderline-elevated FSH with Type 1 diabetes and suboptimal thyroid control (TSH 3.3) creates a clinical picture requiring optimization to protect your long-term fertility.
Understanding Your Hormone Profile
FSH Level of 10.2 IU/L
Your FSH is mildly elevated but not severely abnormal. FSH levels greater than 7.6 IU/L suggest some degree of testicular dysfunction, but this does not mean absent sperm production—your actual sperm count confirms this. 1, 3
Men with FSH levels between 7.5-12 IU/L have a five- to thirteen-fold higher risk of abnormal sperm parameters compared to men with FSH <2.8 IU/L, but many maintain adequate fertility. 4
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 your documented normal sperm count proves you are producing sperm effectively. 1, 2
LH Level of 7.5 IU/L
Your LH is in the upper-normal range, suggesting your pituitary is compensating appropriately for mild testicular resistance. 1
Normal LH with mildly elevated FSH argues against primary testicular failure and indicates preserved Leydig cell function. 1
Testosterone Level of 36.2 nmol/L (approximately 1044 ng/dL)
Your testosterone is in the high-normal to elevated range, making primary testicular failure extremely unlikely. 1
This level is well above the normal adult male range of 300-800 ng/dL cited in most laboratories. 5
Critical Impact of Your Medical Conditions
Type 1 Diabetes Effects on Fertility
Your diabetes directly affects testicular function and explains part of your elevated FSH. 6
Insulin-dependent diabetic men have reduced testicular volume, decreased semen volume, reduced total and total motile sperm output, and elevated LH and FSH levels compared to controls. 6
Glycemic control directly correlates with LH levels (r=0.46, p<0.02), indicating that poor glucose control worsens hypothalamic-pituitary-testicular axis function. 6
The impairment occurs at multiple levels of the reproductive axis and is at least partly reversible with improved glycemic control. 6
Thyroid Dysfunction and TSH of 3.3
Your TSH of 3.3 is suboptimal for fertility and likely contributing to your elevated FSH. 1, 7
Thyroid hormones exhibit critical regulatory effects on testicular development, and both hypo- and hyperthyroidism affect testis size, Sertoli cell function, Leydig cell function, and germ cell proliferation with direct consequences for spermatogenesis. 7
Inadequate thyroid replacement elevates SHBG and impairs spermatogenesis through disruption of the hypothalamic-pituitary-gonadal axis. 1
For men with fertility concerns, bringing TSH into the lower portion of the reference range (ideally 1.0-2.5) is reasonable and may improve your FSH levels. 1
Immediate Action Plan
1. Optimize Thyroid Management
Discuss with your endocrinologist increasing your levothyroxine dose to target TSH 1.0-2.5, as your current TSH of 3.3 is in the upper half of the reference range and may be contributing to elevated FSH. 1
Recheck thyroid function in 6-8 weeks after any dose adjustment. 1
2. Maximize Diabetes Control
Optimize your glycemic control aggressively, as HbA1c levels directly correlate with LH elevation and testicular dysfunction. 6
Work with your diabetes team to achieve the tightest glucose control possible without excessive hypoglycemia risk. 6
3. Repeat Hormonal Assessment
Recheck FSH, LH, testosterone, and TSH after 3-6 months of optimized thyroid and metabolic management to determine if FSH normalizes. 1
FSH levels can fluctuate due to pulsatile secretion and metabolic factors, so repeat testing after optimization is essential. 1
4. Obtain Repeat Semen Analysis
Perform at least one additional semen analysis in 3-6 months to establish whether your sperm parameters are stable or declining. 1
Single analyses can be misleading due to natural variability—you need trend data. 1
Critical Warnings to Protect Your Fertility
Never Use Testosterone or Anabolic Steroids
Exogenous testosterone will completely suppress your sperm production through negative feedback on the hypothalamus and pituitary, causing azoospermia that can take months to years to recover. 1, 2, 3
- Your current testosterone level is already high-normal—there is absolutely no indication for testosterone supplementation. 1
Avoid Gonadotoxic Exposures
Minimize heat exposure to the testes (avoid hot tubs, saunas, laptop computers on lap). 1
If you smoke, quit immediately—smoking significantly elevates FSH and impairs spermatogenesis. 1
Maintain healthy body weight (BMI <25), as obesity impairs male fertility through multiple mechanisms. 1
Fertility Prognosis and Timeline
Natural Conception Probability
Your current fertility status is excellent for natural conception. 1
Your sperm concentration of 56 million/ml with 60% motility yields a total motile sperm count of approximately 33.6 million per ejaculate, which far exceeds the 10 million threshold associated with good natural conception rates. 1
Couples with male TMSC >10 million have excellent natural conception rates, and your TMSC of 33.6 million places you well above this threshold. 1
Female Partner Age Considerations
If your female partner is under 30, you have a >90% chance of achieving pregnancy within 2-3 years of trying with timed intercourse. 1
If no conception occurs after 12 months of timed intercourse, consider fertility evaluation and possible intrauterine insemination (IUI) with ovarian stimulation. 1
Long-Term Monitoring Strategy
Risk of Progressive Decline
Your combination of Type 1 diabetes, suboptimal thyroid control, and borderline-elevated FSH creates risk for progressive spermatogenic decline if not managed properly. 1, 6
- Men with elevated FSH and metabolic conditions are at higher risk for progressive testicular dysfunction over time. 1
Protective Monitoring
Repeat semen analysis every 12 months to track trends. 1
If follow-up semen analyses show declining sperm counts (dropping below 15 million/ml), strongly consider sperm cryopreservation to preserve fertility options. 1
Bank at least 2-3 ejaculates if cryopreservation becomes necessary, as this provides backup samples and maximizes future fertility options. 1
When to Seek Fertility Specialist
Indications for Referral
If no conception after 12 months of timed intercourse despite optimized thyroid and diabetes management. 1
If repeat semen analysis shows declining parameters (concentration dropping below 15 million/ml or motility below 40%). 1
If FSH rises above 12 IU/L on repeat testing despite metabolic optimization. 1
Assisted Reproductive Options if Needed
IUI may be considered if TMSC remains >5 million after processing. 3
IVF with ICSI is highly effective even with poor sperm parameters and offers superior pregnancy rates compared to empiric hormonal therapy. 1, 3
Key Pitfalls to Avoid
Do not interpret your FSH of 10.2 as indicating infertility—your documented sperm count proves you have adequate production. 1, 2
Do not accept TSH of 3.3 as adequate for fertility optimization—target lower TSH (1.0-2.5) for best reproductive outcomes. 1
Do not delay addressing glycemic control—diabetes directly impairs testicular function in a dose-dependent manner. 6
Do not use testosterone supplementation under any circumstances if you desire current or future fertility. 1, 2, 3