Fertility Preservation in Men with Testicular Dysfunction

Introduction to Fertility Preservation

• The American Society for Reproductive Medicine recommends that men with elevated FSH levels (>7.6 IU/L) freeze multiple sperm samples while parameters are still normal, as this provides insurance against future decline 1
• The American Urological Association recommends collecting at least three ejaculates if total motile count is adequate, with each collection aliquoted to obtain >5 million total motile sperm per sample 5, 6

Understanding Testicular Dysfunction

• Testicular atrophy suggests underlying testicular dysfunction and reduced spermatogenic capacity 2, 3
• FSH levels are negatively correlated with spermatogonia numbers—higher FSH indicates the pituitary is compensating for reduced testicular function, signaling progressive testicular failure 3, 1

Importance of Sperm Cryopreservation

• Sperm cryopreservation is the most effective method of fertility preservation in postpubertal males, according to the 2025 ASCO guidelines 7, 8, 5
• Even one collection is important to obtain if possible, and sperm should be cryopreserved in multiple aliquots from a single sample to facilitate options for multiple cycles of insemination or IVF 7, 8, 5

Evaluating Reversible Causes of Testicular Dysfunction

• A complete hormonal panel should be measured to evaluate the entire hypothalamic-pituitary-gonadal axis 1
• Thyroid function should be checked, as thyroid dysfunction can disrupt gonadotropin secretion and impair spermatogenesis 3, 1

Practical Recommendations for Fertility Preservation

• Freeze at least three separate ejaculate samples over several days, with each collection aliquoted to obtain total motile count >5 million per sample 5, 6, 1
• Repeat semen analysis every 6-12 months to monitor for decline, as changes in semen parameters take time to manifest and may not be apparent on a single analysis 4, 3, 1