Should I be concerned about my fertility with a sperm count of 60 million per milliliter, FSH (Follicle-Stimulating Hormone) level of 9.9, and testicular volume of 10-12 milliliters?

Your Fertility Parameters Are Reassuring and Do Not Warrant Concern

With a sperm concentration of 60 million/mL—nearly 4 times the WHO lower reference limit of 16 million/mL—combined with testicular volumes of 10-12 mL and FSH of 9.9 IU/L (within the normal range of 1-12.4 IU/L), you have documented normal sperm production and should not be worried about your current fertility status. 1

Understanding Your Sperm Count

Your sperm concentration of 60 million/mL places you well within the fertile range:

• The WHO defines normal sperm concentration as ≥16 million/mL, and your count of 60 million/mL significantly exceeds this threshold 1
• Assuming normal semen volume (≥1.4 mL), your total sperm number likely exceeds 84 million per ejaculate, far above the WHO lower reference limit of 39 million 1
• Research suggests that sperm concentrations above 40 million/mL are associated with optimal fertility and shorter time to pregnancy 2, 3

Your sperm count alone confirms normal spermatogenesis, regardless of other parameters.

Interpreting Your FSH Level

Your FSH of 9.9 IU/L falls within the normal laboratory reference range (1-12.4 IU/L) and does not indicate testicular dysfunction:

• FSH levels >7.6 IU/L are associated with non-obstructive azoospermia only when accompanied by testicular atrophy and absent sperm production—which clearly does not apply to you given your documented normal sperm count 1, 4
• The correlation between FSH and sperm production is not absolute; some men maintain normal fertility with FSH levels in the 10-12 IU/L range 4
• Research shows that FSH >7.5 IU/L increases the risk of abnormal sperm concentration (meaning reduced counts), not zero sperm production 5

The key point: FSH levels between 7.6-10 IU/L typically indicate some degree of impaired spermatogenesis efficiency, but your actual sperm count of 60 million/mL proves you do not have clinically significant impairment. 4

Understanding Your Testicular Volume

Testicular volumes of 10-12 mL are at the lower end of normal but not definitively atrophic:

• Volumes <12 mL are generally considered small or borderline-atrophic and warrant clinical correlation 6
• However, testicular volume strongly correlates with total sperm count, and your documented sperm concentration of 60 million/mL indicates that your testes are functioning adequately despite being on the smaller side 7
• Men with testicular volumes of 10-12 mL typically have oligospermia (reduced counts) rather than azoospermia (zero sperm), and your count of 60 million/mL confirms you are not even oligospermic 4

Your testicular volume represents reduced testicular reserve, meaning you have less capacity to compensate if additional stressors occur, but your current sperm production is normal. 4

What This Combination Means

The pattern of borderline-small testes with upper-normal FSH and documented normal sperm count indicates:

• Your testes are working harder (reflected by FSH of 9.9 IU/L) to maintain normal sperm production despite smaller testicular volume 4
• This represents compensated testicular function—your pituitary is appropriately stimulating your testes with FSH, and your testes are responding by producing normal sperm numbers 4
• You do not have primary testicular failure, which would show FSH >12 IU/L with severely reduced or absent sperm production 4

Critical Actions to Protect Your Fertility

While your current fertility is normal, your reduced testicular reserve means you should take specific protective actions:

Absolutely Avoid:

• Never use exogenous testosterone or anabolic steroids if you desire current or future fertility—these completely suppress spermatogenesis through negative feedback and can cause azoospermia that takes months to years to recover 1, 4

Lifestyle Optimization:

• Maintain healthy body weight (BMI <25), as obesity impairs male fertility 4
• Avoid smoking and minimize alcohol consumption 4
• Minimize heat exposure to the testes (avoid hot tubs, saunas, laptop computers on lap) 4

Monitoring Strategy:

• Repeat semen analysis in 6-12 months to establish whether your parameters are stable or declining, as single analyses can be misleading due to natural variability 4
• If sperm concentration drops below 20 million/mL on repeat testing, obtain hormonal evaluation including LH and testosterone 4
• Consider sperm cryopreservation (banking 2-3 ejaculates) if follow-up shows declining trend, especially if concentration approaches 20 million/mL 4

When to Seek Further Evaluation

You should obtain additional workup only if:

• Repeat semen analysis shows sperm concentration declining to <20 million/mL 4
• You develop symptoms of testosterone deficiency (decreased libido, erectile dysfunction, fatigue) 4
• You and your partner have been trying to conceive for >12 months without success 4
• You notice rapid testicular atrophy or develop a palpable testicular mass 4

Fertility Prognosis

Your fertility prognosis is excellent:

• With a sperm concentration of 60 million/mL and assuming normal motility and morphology, your total motile sperm count likely exceeds 36 million per ejaculate, far above the 10 million threshold associated with good natural conception rates 4
• Couples with male total motile sperm count >10 million have >90% chance of achieving pregnancy within 2-3 years of trying if the female partner is under 30 years old 4

Bottom line: Your documented sperm count of 60 million/mL proves you have normal spermatogenesis. The borderline-small testicular volume and upper-normal FSH simply indicate your testes are working efficiently to maintain this normal production. You should not be worried about your current fertility status, but should protect your fertility by avoiding testosterone/steroids and maintaining healthy lifestyle habits. 1, 4