Zeng Chunhua, Reproductive Center, Xiamen Maternal and Child Health Hospital According to the guidelines for the diagnosis and treatment of male infertility, the main causes of reduced fertility in men are congenital and acquired genitourinary tract malformations, reproductive tract infections, elevated scrotal temperature (varicocele), endocrine disorders, genetic defects and immune factors. It may seem obvious at a glance, but what exactly causes infertility in each individual patient is often a difficult question to answer. “Because one thing that characterizes male infertility is that there are so many unexplained conditions.” The so-called unexplained, also called idiopathic infertility, refers to couples applying the existing means of examination are not obvious abnormalities, but did not conceive a child; or, the examination is simply the male semen quality is not very good, semen analysis shows oligospermia, weak spermatozoa and deformed spermatozoa, but do not know what causes, known as the “idiopathic semen abnormalities”. Among the causes of male infertility, this unexplained or idiopathic semen abnormality accounts for the largest proportion, up to 60-75%. Varicocele only accounts for 12.3%, genitourinary tract infections are only 6.6%, and other factors are even less. Although there are many causes of infertility, they are basically reflected in the semen, whether good or bad. A semen analysis test, therefore, is one of the most routine tests. Just how much weight does a semen test result carry? In the men’s clinic, a patient put a semen report card on the table, and after the doctor looked at it, he said, “This test result shows that the quality of semen is not good!” When the patient heard this, he immediately became nervous, “What should I do? Do I need treatment? Can it be treated?” “In fact, just one abnormal semen report does not mean anything, it must be reviewed again.” This is what male doctors often tell their patients. This is because the growth cycle of sperm is usually 3 months, during which it changes dynamically and each day may be different. The World Health Organization has had a survey, the researchers have given birth to a number of men every two weeks for semen examination, the results found that the highest sperm count, up to more than 100 million, but some patients if the examination, just in a cold or tired state, then the sperm count may fall to more than 2 million at once. As a result, “estimating infertility with a semen test is only 70% accurate!” To further illustrate, “Even if the semen test is abnormal, it cannot be said to be infertile, only that, its semen quality is poor, but the possibility of fertility, is still there.” And, even if all tests (including the semen test) are normal, male-induced infertility cannot be ruled out, which would fall into the category of idiopathic infertility described earlier. In fact, the real value of semen analysis lies only in facilitating the physician’s ability to distinguish between three states: low fertility, uncertain fertility, and good fertility. If a patient is found to have oligospermia (total number of sperm less than 20 million/mL), or hypospermia (sperm viability <50%< span="">), or dyszoospermia (sperm of normal morphology <14%< span="">), in which case fertility may be low, but it does not necessarily mean that infertility is present. In other words, none of the items in the semen test can be used as a diagnostic indicator of infertility, but only as a reference to understand the likelihood of infertility. Of course, if the man belongs to severe oligospermia, or even azoospermia, or severe weak spermatozoa, malformed spermatozoa, etc., it is difficult to shirk the responsibility of infertility. However, “fertility is a ‘cooperative project’ between husband and wife,” and if the woman is in relatively good health, she can compensate for problems in the area of low male fertility. Just like varicocele, while it has an effect on semen, its role in infertility only manifests itself when the woman also has reduced fertility. “Fertility is like planting,” we say, with the man providing the “seed” and the woman the “soil”. If the “seed” and the “soil” are good, growth and development will naturally proceed smoothly. If the “seed” is good, but the “soil” is not good, or even “barren”, it will be more difficult to grow; but on the other hand, sometimes, even if the “seed” is not good, the “soil” is not good, or even “barren”, it will be more difficult to grow. On the other hand, there are times when even if the “seed” is not good, but the “soil” is fertile enough, the “seed” may grow and develop well.