Your Normal Sperm Count is Correct
Your sperm count of 56 million/mL is the accurate indicator of your current reproductive health, not the FSH level of 10.4 mIU/mL. The sperm count directly measures what matters most—actual sperm production—while FSH is an indirect marker that can be elevated for multiple reasons even when sperm production remains normal 1.
Why the Sperm Count Takes Priority
Your sperm concentration of 56 million/mL significantly exceeds the WHO lower reference limit of 16 million/mL, placing you well within the normal fertile range and confirming adequate spermatogenesis 1.
FSH levels between 7.6-10.4 IU/L can occur in men with completely normal sperm production, as FSH represents the pituitary's signaling effort rather than actual testicular output 1, 2.
The guideline threshold of FSH >7.6 IU/L was established for men with azoospermia (zero sperm) or severe oligospermia (<5 million/mL), not for men with normal counts like yours 1, 3.
Understanding the FSH Elevation
Your FSH of 10.4 IU/L is mildly elevated but does not contradict your normal sperm production:
FSH levels show variable correlation with actual sperm retrieval outcomes—up to 50% of men with non-obstructive azoospermia and elevated FSH still have retrievable sperm, demonstrating that FSH alone cannot definitively predict fertility status 1, 2.
Men with maturation arrest on testicular histology can have normal FSH despite severe spermatogenic dysfunction, while others maintain normal fertility despite FSH levels of 10-12 IU/L 1, 3.
FSH can be transiently elevated by metabolic stress, obesity, thyroid dysfunction, acute illness, or natural biological variation—factors that don't necessarily reflect permanent testicular damage 1, 2.
What This Means for Your Fertility
Your total motile sperm count (assuming normal motility) would be approximately 28-42 million per ejaculate, which far exceeds the 10 million threshold associated with good natural conception rates 1.
Research shows that men with FSH >7.5 IU/L have a five- to thirteen-fold higher risk of abnormal sperm concentration, but this refers to reduced counts, not zero sperm—and your count is normal 4.
The combination of mildly elevated FSH with normal sperm count suggests you have adequate testicular reserve despite some degree of compensatory pituitary signaling 1, 2.
Essential Next Steps
Repeat semen analysis in 3-6 months to confirm stability of your sperm parameters, as single analyses can be misleading due to natural variability 1, 2.
Measure complete hormonal panel including testosterone, LH, and prolactin to evaluate your entire hypothalamic-pituitary-gonadal axis 1, 2.
Address any reversible factors that could be elevating FSH:
- Check thyroid function (TSH, free T4) as thyroid disorders commonly affect reproductive hormones 1
- Assess metabolic parameters including BMI and waist circumference 2
- Evaluate for medications or substances that interfere with the HPG axis 2
Critical Pitfall to Avoid
Never start testosterone therapy if you desire current or future fertility—exogenous testosterone will completely suppress spermatogenesis through negative feedback, potentially causing azoospermia that takes months to years to recover 1, 2, 3.
The Bottom Line
Your documented sperm count of 56 million/mL is objective evidence of normal spermatogenesis. The FSH of 10.4 IU/L indicates your pituitary is working harder to maintain this production, but the end result—normal sperm count—is what determines your fertility potential. Focus on the output (sperm count), not just the signaling hormone (FSH) 1, 2.