Santi D, Corona G, Salonia A, Ferlin A
Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
Endocrinology Unit, Azienda AUSL, Bologna, Italy.
J Endocrinol Invest. 2025 May;48(5):1085-1100. doi: 10.1007/s40618-024-02524-x. Epub 2025 Jan 13.
Infertility is defined as the inability to conceive after 1 year of unprotected intercourse, affecting approximately 15-20% of couples in Western countries. It is a shared problem within the couple; when the main issue lies with one of the partners, it is preferable to refer to "male factor" or "female factor" infertility rather than simply male or female infertility. Despite male factor infertility accounting for half of all couple infertility cases, the clinical approach to the male partner is not uniformly standardized across international guidelines.
To provide an expert overview, we have comprehensively reviewed and critically analyzed the most up-to-date literature on this sensitive topic, leading to the development of a proposal for tailored assessment of the diagnostic-therapeutic pathway and preventive strategies. The diagnostic approach also considers that infertile men are objectively less healthy than their fertile counterparts of the same age and ethnicity.
This article discusses the diagnostic flow, the classification of male factor infertility, the definition of idiopathic infertility, the involvement of general health, and treatment recommendations, emphasizing follicle-stimulating hormone treatment in selected groups of patients.
We provide expert opinion on current drawbacks and future perspectives in this field, with practical advice for the clinical practice of general practitioners and expert in reproductive medicine.
不孕症被定义为在无保护性交1年后仍无法受孕，在西方国家约15%-20%的夫妇受其影响。这是夫妻双方共同面临的问题；当主要问题出在一方时，最好称其为“男性因素”或“女性因素”不孕症，而非简单的男性或女性不孕症。尽管男性因素不孕症占所有夫妻不孕症病例的一半，但国际指南中针对男性伴侣的临床治疗方法并不统一规范。
为提供专家综述，我们全面回顾并批判性分析了关于这一敏感话题的最新文献，进而制定了一份针对诊断-治疗路径及预防策略的个性化评估建议。诊断方法还考虑到，客观上不育男性的健康状况不如同年龄、同种族的可育男性。
本文讨论了诊断流程、男性因素不孕症的分类、特发性不孕症的定义、总体健康状况的影响以及治疗建议，重点强调了特定患者群体的促卵泡激素治疗。
我们针对该领域当前的不足和未来前景提供专家意见，并为全科医生和生殖医学专家的临床实践提供实用建议。
