This article is not an introduction to the significance of the parameters on the semen test report form, as many have been covered before this. I am writing this article mainly to correct the problem that some doctors and patients rely too much on the semen test report and put too much attention on the semen test report. First, let’s start with a news story: Recently, the sensational case of a 56-day-old baby girl in Beijing who was tragically killed by four steel needles inserted into her body and nearly died was finally solved. The police have confirmed that the killer is the baby girl’s biological father. The baby girl’s father suspected that his daughter was not his own child because he had undergone a semen test and was told by the doctor that the semen quality was abnormal, but DNA verification by the police proved that the baby girl, Xiao Shengjie, was indeed the biological daughter of her father, Yin Zhi He! Police said that Yin Zhi He acted suspected of intentional homicide and has now placed him in criminal detention. Why would the father do it to his daughter? It’s because he had a semen test and found abnormal semen quality and thought he couldn’t have children, so he decided they weren’t his own! This news tells us that in a society where male fertility is declining and new, more objective and accurate tests to detect male fertility are slow to be found, it is urgent to make patients correctly understand the significance of semen tests, and doctors and patients can no longer simply and one-sidedly view semen test results, or even exaggerate the significance of semen tests. It is undeniable that semen examination is indeed a more accurate and intuitive test that reflects a man’s fertility under existing conditions, but it does not mean that semen examination is the gold standard, and when patients and doctors focus all their attention on semen examination results, they are deviating from the direction of male treatment. Since semen test results are highly volatile, the same person, in the same physiological state, without any human intervention, cannot have his semen test done at two different times exactly the same. A test with such high volatility is not destined to be the gold standard, so it can only be a reference. A man’s fertility and the results of his semen test should be positively correlated, but not directly proportional. Sometimes it is not uncommon for a man to have a semen test result that is not very good, yet he is fertile. Therefore, when we see a man with abnormal semen test results, it does not mean that he is absolutely infertile, it only means that his fertility may be lower than normal (except for azoospermia, dead sperm and very severe oligo-weak teratospermia), at most it is considered relatively infertile, as to how much lower, it is not quantifiable. For example, it is recognized worldwide that smoking can cause lung cancer, but it does not mean that smoking will definitely lead to lung cancer, it just means that the chance of getting lung cancer is greater for smokers than for non-smokers. In addition, the fact that some people smoke two packs of cigarettes a day and some people smoke one pack of cigarettes a day does not mean that a person who smokes two packs of cigarettes has twice the chance of getting lung cancer as a person who smokes one pack of cigarettes, because this is not quantifiable. In my clinic, I often encounter patients who ask me with the report of semen test, “Doctor, how much worse my semen is compared with normal people, does it mean that my fertility is only a few percent of normal people?” “Doctor, does the fact that I improved by a few percentage points in this test compared to the last test mean that my fertility has improved by a few percent?” That’s really not the case. Sometimes I see patients who are happy when their semen test parameters improve after a review, and who are downhearted when they don’t improve or even drop, and even suspect that the doctor’s medication has caused their semen parameters to drop. In fact, there is no need to be like this, the mindset is normal, the parameters can improve is certainly good, can not improve does not mean bad. I have met a few patients who are particularly good medical practitioners and who are more receptive to advice. Although their semen parameters did not improve after 2-6 months of treatment, I still advised them to actively prepare for pregnancy because their semen quality was not very poor, and they eventually became pregnant after coitus. This certainly has the possibility of luck, but it does not exclude that although their semen test results did not improve, their actual fertility did. After all, these patients all had at least a year’s history of infertility, and one even had a history of infertility for more than 3 years, so their fertility cannot be explained entirely by luck. Why would this be the case? I think, on the one hand, nowadays, male medicine is basically using some sperm-producing and sperm-enhancing drugs, whether they are Chinese or Western. Due to the complexity and uncertainty of male treatment, there is still an unwritten consensus among most male physicians that they do not want to be successful, but to be free of faults. This view, although negative, has made such drugs as vitamins E and C, folic acid, leucovorin, zinc and other such drugs commonly used in male medicine. Obviously, these types of drugs are all beneficial and harmless for fertility, as well as for the improvement of sperm quality (perhaps zinc is somewhat controversial), so there should be some improvement in fertility after taking them. Of course, due to the empty and generalized medication, which is not targeted and not symptomatic (for example, there are reproductive tract infections without anti-infection, and endocrine abnormalities without endocrine regulation), sometimes this improvement is very small, and even the semen review parameters do not change significantly, or even worse, sometimes worse due to the patient’s own fluctuations, but in the end, it is still beneficial. This is like a woman who also used to take vitamin E and C before giving birth to a child, she will not have more normal menstruation or more normal ovulation, but everyone knows that it is beneficial. So with the use of sperm benefiting drugs, even if there is no significant improvement in semen on recheck, fertility will definitely be better than before. On the other hand, the parameters of a semen test are only those that can be checked under existing medical conditions, it does not mean that these are the only parameters to evaluate a single semen. It’s like a person who goes for a medical checkup, and with the current level of treatment in medical checkup centers, only routine blood and urine tests, chest X-ray, electrocardiogram, biochemical complete set, etc. can be routinely checked. Maybe there is a person who has been feeling insomnia, forgetfulness, irritability, poor energy and stamina, but he goes for a physical examination and his blood, urine, biochemistry, etc. are all normal. After a period of recuperation, he felt significantly better, and all the symptoms of insomnia and irritability disappeared, but when he went for physical examination again, the blood, urine routine, biochemical complete set, chest X-ray and ECG were still the same, nothing changed. The same is true for semen examination. Maybe you go for a recheck and there is no improvement, but in fact the quality of your semen is much better than before. Since there are no other better tests or methods available to assess male fertility, semen testing is still the most important test, but we must remember not to rely too much on or stress too much about semen test results.