Should I be concerned about my fertility with an FSH level of 9.9, sperm count of 60 million/mL, and testicular volume of 9mL?

Should You Be Concerned About Your Fertility?

Your fertility parameters are reassuring and do not warrant significant concern. Your sperm count of 60 million/mL is nearly 4 times the WHO lower reference limit of 16 million/mL, placing you well within the normal fertile range, despite your borderline testicular volume 1.

Understanding Your Test Results

Sperm Count Analysis

• Your sperm concentration of 60 million/mL significantly exceeds the WHO threshold of 16 million/mL for normal fertility 1
• Assuming normal ejaculate volume (≥1.5 mL), your total sperm count likely exceeds 90 million per ejaculate, which is more than double the WHO lower reference limit of 39 million 1
• These parameters indicate preserved spermatogenic function despite reduced testicular volume 1

FSH Level Interpretation

• Your FSH of 9.9 IU/L falls within the normal laboratory range (1-12.4 IU/L) but is in the upper portion 1
• FSH >7.6 IU/L typically indicates some degree of testicular stress or compensatory response, but this does not preclude normal sperm production 1
• The key finding is that your actual sperm count is normal, which demonstrates that your testes are functioning adequately despite the borderline-elevated FSH 1, 2

Testicular Volume Concerns

• Your testicular volume of 9 mL is below the normal threshold of 12 mL and indicates reduced testicular reserve 1, 3
• However, testicular volume does not determine fertility status—actual sperm production does 1, 2
• Studies show that total testicular volume below 20 mL (by ultrasound) or 30 mL (by orchidometer) correlates with oligospermia, but you have documented normal sperm counts 3
• Men with testicular volumes of 9 mL can maintain normal spermatogenesis, as evidenced by your sperm count 4, 5

Critical Protective Actions

What You Must Avoid

• Never use exogenous testosterone or anabolic steroids if you desire current or future fertility—these completely suppress FSH and LH through negative feedback, causing azoospermia that can take months to years to recover 1
• Avoid gonadotoxic exposures including excessive heat to the scrotum, smoking, and occupational toxins 1

Fertility Preservation Strategy

• Consider sperm cryopreservation now as insurance against future decline 1
• Bank 2-3 separate ejaculates with 2-3 days abstinence between collections 1
• Your reduced testicular volume (9 mL) places you at higher risk for progressive spermatogenic decline over time 1, 3
• Once azoospermia develops, even microsurgical testicular sperm extraction only achieves 40-50% sperm retrieval rates 1

Essential Monitoring Protocol

Repeat Semen Analysis

• Obtain repeat semen analysis in 3-6 months to establish whether parameters are stable or declining 1
• Single analyses can be misleading due to natural variability 1

Complete Hormonal Evaluation

• Measure LH and total testosterone to fully characterize your hypothalamic-pituitary-testicular axis 1, 2
• Calculate free testosterone if SHBG is available 1
• Check thyroid function (TSH, free T4) as thyroid disorders commonly affect reproductive hormones 1

Physical Examination

• Evaluation by a male reproductive specialist or urologist for testicular consistency, presence of varicocele, and vas deferens/epididymal abnormalities 1
• Varicocele repair can improve semen parameters and halt testicular atrophy progression if a palpable varicocele is present 1

Genetic Testing Considerations

Genetic testing is NOT currently indicated for you because:

• Karyotype analysis and Y-chromosome microdeletion testing are recommended only when sperm concentration is <5 million/mL with elevated FSH 1, 6
• Your sperm count of 60 million/mL is 12 times higher than this threshold 1
• However, if follow-up semen analysis shows declining counts approaching 5 million/mL, genetic testing should be performed 1

Fertility Timeline and Natural Conception

• With your current sperm parameters, you have excellent potential for natural conception 1
• A total motile sperm count >10 million is associated with good natural conception rates 1
• Female partner age is the most critical factor determining conception success 1
• If no conception occurs after 12 months of timed intercourse, consider fertility evaluation and possible intrauterine insemination with ovarian stimulation 1

Important Caveats

Why Testicular Volume Matters Despite Normal Sperm Count

• Reduced testicular volume indicates diminished testicular reserve, meaning less "buffer" against future insults 1, 4
• Biofunctional sperm parameters (mitochondrial function, DNA integrity, chromatin compactness) worsen with decreasing testicular volume even when sperm count remains normal 4
• Your borderline FSH suggests your pituitary is already working harder to maintain normal sperm production 1

Long-term Health Implications

• Men with abnormal semen parameters or reduced testicular volume have higher rates of testicular cancer and increased mortality compared to fertile men 1
• This evaluation is important for overall health screening, not just fertility 1
• Consider this an opportunity to optimize metabolic health, maintain healthy body weight (BMI <25), and address any underlying conditions 1