Prince Henry's Institute of Medical Research, P.O. Box 5152, Clayton 3168, Australia.
J Clin Endocrinol Metab. 2013 Mar;98(3):873-80. doi: 10.1210/jc.2012-3650.
Male infertility affects 1 in 20 men and is the sole or contributory factor in half of assisted reproductive treatments (ARTs). A reduced sperm density (oligozoospermia) is often accompanied by poor motility and morphology reflecting qualitative and quantitative defects in spermatogenesis. Many reproductive and nonreproductive disorders and treatments may be responsible, but most cases remain unexplained (idiopathic). A thorough evaluation may identify treatable causes and allow natural fertility. Comorbidities more prevalent in infertile men, especially androgen deficiency and testicular cancer, should be sought. Idiopathic spermatogenic disorders are common, but evidence-based treatment is not available; full evaluation informs management and the decision to pursue ART using the low numbers of functional sperm available. Chromosomal anomalies may impact the chance of a normal healthy pregnancy, and new genetic causes of oligozoospermia are being discovered. ART, particularly intracytoplasmic sperm injection, bypasses instead of treats the sperm defect but has dramatically improved the fertility prospects. The clinical approach to the oligozoospermic man involves understanding reproductive endocrinology, aspects of urology and clinical genetics, modern ART options, and the realistic discussion of their outcomes, alternatives such as adoption or donor gametes, and appreciation of the psychosocial concerns of the couple.
男性不育影响了 1/20 的男性，并且是一半辅助生殖治疗（ART）的唯一或促成因素。精子密度降低（少精症）通常伴随着运动能力和形态的下降，反映了精子发生的定性和定量缺陷。许多生殖和非生殖疾病和治疗可能是原因，但大多数情况仍无法解释（特发性）。彻底的评估可以确定可治疗的原因，并允许自然生育。应寻找在不育男性中更常见的合并症，特别是雄激素缺乏症和睾丸癌。特发性精子发生障碍很常见，但没有基于证据的治疗方法；全面评估可以为管理和决定使用现有的少量功能精子进行 ART 提供信息。染色体异常可能会影响正常健康妊娠的机会，并且正在发现新的少精症遗传原因。ART，特别是胞浆内精子注射，绕过而不是治疗精子缺陷，但极大地提高了生育前景。少精症男性的临床处理方法涉及了解生殖内分泌学、泌尿科和临床遗传学的各个方面、现代 ART 选择以及对其结果、替代方案（如收养或供体配子）的现实讨论，以及对夫妇的心理社会问题的认识。
