The ability of human reproduction is the result of hundreds of millions of years of evolution in nature, and the current level of medical technology is far from being able to decipher the mystery of it, and there are many selection processes in natural reproduction that cannot be imitated in assisted reproduction technology, so natural reproduction should be advocated. With the great industrialization of modern life and production methods, human beings are now affected and disturbed by dietary pollution, environmental damage, emotional stress and irregularities in life hundreds of times more than they were hundreds of years ago. According to the analysis of epidemiological data and laboratory results in many countries, the proportion of infertile couples is now more than 10%, of which the male factor alone is about one-third, and the quality of male semen is gradually declining compared to the previous trend. The International Health Organization (WHO) in the latest version of the “WHO Laboratory Manual for the Examination and Processing of Human Semen, Fifth Edition” correspondingly lowered the reference value of normal semen examination significantly. Currently, male infertility is commonly seen in clinical practice as oligospermia, weak and malformed spermatozoa, the causes of which are complex and many of which cannot be found for definite reasons, called idiopathic oligospermia, weak and malformed spermatozoa. Currently, with the development of reproductive technologies, especially the gradual update and improvement of IVF-ET (conventional IVF), ICSI-ET (single sperm intracytoplasmic injection), and PGD/PGS (pre-transplant genetic diagnosis/screening), many couples who were otherwise hopeless can have normal offspring. It can be said that today’s male infertility treatment is an era of assisted reproductive technology, and many men for whom conservative medication has failed may eventually resort to assisted reproductive technology. Our experience with male oligospermia, weakness and malformation is that first of all, we need to improve our dietary habits, which is the basis of all treatment. Many male patients with mild semen quality abnormalities can return to normal through 1 to 3 months of adjustment, and very good results can be achieved without any other treatment. In the case of moderate to severe semen quality abnormalities, medication should be given for more than one course of treatment (3 months) based on improved lifestyle and diet, and depending on the results of the treatment, one can then choose whether to continue the medication or switch to IUI or IVF. Nowadays, fertility treatments are designed to increase the chances of fertility, and there is no 100% certainty of success. It is estimated that if a couple with normal fertility has reasonable and regular sex for one month, the chances of conception are 20-25%, 50-60% for three months, about 70% for six months, and close to 90% for 12 months. It is good that semen can improve significantly after treatment, even if it is completely normal, it only increases the chances. A course of medication for men with low, weak, or abnormal spermatozoa can significantly improve semen quality and increase the chances of natural fertility in about 60% of patients. Among the current assisted reproductive technologies, intrauterine insemination is closer to the natural process (single clinical pregnancy rate of about 15%), while various in vitro techniques (single clinical pregnancy rate of about 40-60%) have certain genetic risks and more preterm and low birth weight babies, and even more psychological disorders occur. Assisted reproduction will have a higher rate of miscarriage, so the final live birth rate will be lower, and the procedure is expensive and cumbersome, so being able to increase the chances of natural fertility with simple medication is the beginning of all male infertility treatments. Therefore the current guidelines to follow for male fertility treatment I summarize as follows: natural pregnancy is the ideal, the principle of downgrading is the key, and assistive technology is the core. In short, the ideal outcome of treatment is to be able to have children naturally with simple lifestyle adjustments and medication, and if natural fertility is not possible, artificial insemination can be done with the help of medication if IVF was originally done (downgrading principle), but for those who have not had children for a long time with medication or whose semen quality is very poor and is assessed to have little hope of improvement, assisted reproductive technology should be decisively recommended.