I'm a male with a follicle-stimulating hormone (FSH) level outside the normal range, but my semen analysis shows a good sperm count of 60 million per milliliter (ml) and 50% motility, should I be concerned about my fertility?

No, You Should Not Be Concerned About Your Fertility

With an FSH of 10 IU/L, sperm count of 60 million/mL, and 50% motility, your fertility parameters are excellent and far exceed the thresholds associated with good natural conception rates. Your semen analysis demonstrates normal fertility despite the borderline FSH elevation.

Understanding Your Results

Your Sperm Parameters Are Excellent

• Your sperm concentration of 60 million/mL is nearly 4 times higher than the WHO lower reference limit of 16 million/mL, placing you well within the normal fertile range 1
• Your 50% motility exceeds the normal threshold and indicates good sperm function 1
• Your total progressive motile sperm count (TPMC) is approximately 30 million per ejaculate (assuming 1mL volume), which far exceeds the 10 million threshold associated with good natural conception rates 2
• Partners of men with TPMC values in your range have excellent natural conception rates, with values up to 100-150 million still associated with progressively better outcomes 2

Your FSH Level Does Not Contradict Good Sperm Production

• An FSH of 10 IU/L is only mildly elevated and falls well within your laboratory's reference range of 1-12.4 IU/L 1
• FSH levels show natural variation among healthy men, with some individuals maintaining levels in the 10-12 IU/L range while maintaining completely normal fertility 1
• The key principle is that FSH levels are negatively correlated with sperm production on average, but this correlation is not absolute—your actual sperm count is the definitive measure 1, 3
• Historical case reports document men with elevated FSH (even higher than yours) who maintained normal sperm counts and proven fertility, representing "compensated primary testicular disease" where normal sperm production is maintained despite mildly elevated FSH 4

Why the Apparent Contradiction Exists

FSH Reflects Testicular "Effort," Not Always Outcome

• Your mildly elevated FSH likely indicates your testes require slightly more hormonal stimulation to maintain spermatogenesis, but the critical point is that they are successfully responding to that stimulation 1, 4
• Men with FSH >7.5 IU/L have a five- to thirteen-fold higher risk of abnormal sperm concentration compared to men with FSH <2.8 IU/L, but "abnormal" in that study meant reduced counts—not zero, and certainly not as high as your 60 million/mL 5
• The studies suggesting FSH of 10 predicts abnormal semen are based on population averages and thresholds for increased risk, not absolute predictions for individual patients 5

Your Actual Sperm Count Trumps Statistical Predictions

• FSH levels alone cannot definitively predict fertility status or sperm production in all cases—the actual semen analysis is the gold standard 1, 3
• Some men with maturation arrest on testicular histology can have normal FSH despite severe spermatogenic dysfunction, and conversely, some men with elevated FSH maintain excellent sperm production 1, 3
• Your documented sperm count of 60 million/mL with 50% motility definitively proves you have robust spermatogenesis regardless of the FSH level 1

What You Should Do

Confirm Stability with Repeat Testing

• Obtain a repeat semen analysis in 3-6 months to establish whether your parameters are stable, as single analyses can show natural variability 1
• Recheck FSH, LH, and total testosterone at the same time to provide a complete hormonal picture 1

Protect Your Fertility Going Forward

• Never use exogenous testosterone or anabolic steroids, as these completely suppress spermatogenesis through negative feedback and can cause azoospermia that takes months to years to recover 1, 6, 3
• Optimize modifiable factors: smoking cessation, maintain healthy body weight (BMI <25), minimize heat exposure to the testes, and avoid gonadotoxic medications when possible 1
• If you have a palpable varicocele on examination, discuss with a urologist whether repair might further optimize your parameters 1

Conception Timeline Expectations

• With your sperm parameters, you and your partner have an excellent prognosis for natural conception 2
• Couples with male TPMC >10 million (yours is approximately 30 million) have good natural conception rates, with >90% achieving pregnancy within 2-3 years if the female partner is under 30 1
• Consider fertility evaluation only if no conception occurs after 12 months of timed intercourse, or earlier if your female partner has known fertility factors 1

Important Caveats

• Your mildly elevated FSH suggests you have reduced testicular reserve compared to men with FSH <4.5 IU/L, meaning you should be more vigilant about protecting your fertility from environmental and lifestyle factors 5
• If follow-up semen analysis shows declining sperm concentration (approaching 20 million/mL or below), consider sperm cryopreservation as insurance, banking 2-3 separate ejaculates 1
• Avoid any medications or supplements that could affect the hypothalamic-pituitary-gonadal axis without discussing with a reproductive specialist first 1

Bottom line: Your actual sperm production is excellent and is what matters for fertility, not the FSH number in isolation. The mildly elevated FSH simply indicates your testes are working slightly harder to maintain this excellent output, but they are succeeding.