Journal of Assisted Reproduction and Genetics ( IF 3.2 ) Pub Date : 2021-01-02 , DOI: 10.1007/s10815-020-02037-5 Swati Pandruvada 1 , Rachel Royfman 1 , Tariq A Shah 2 , Puneet Sindhwani 2 , James M Dupree 3 , Samantha Schon 4 , Tomer Avidor-Reiss 1, 2
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Semen analysis is the cornerstone of evaluating male infertility, but it is imperfect and insufficient to diagnose male infertility. As a result, about 20% of infertile males have undetermined infertility, a term encompassing male infertility with an unknown underlying cause. Undetermined male infertility includes two categories: (i) idiopathic male infertility—infertile males with abnormal semen analyses with an unknown cause for that abnormality and (ii) unexplained male infertility—males with “normal” semen analyses who are unable to impregnate due to unknown causes. The treatment of males with undetermined infertility is limited due to a lack of understanding the frequency of general sperm defects (e.g., number, motility, shape, viability). Furthermore, there is a lack of trusted, quantitative, and predictive diagnostic tests that look inside the sperm to quantify defects such as DNA damage, RNA abnormalities, centriole dysfunction, or reactive oxygen species to discover the underlying cause. To better treat undetermined male infertility, further research is needed on the frequency of sperm defects and reliable diagnostic tools that assess intracellular sperm components must be developed. The purpose of this review is to uniquely create a paradigm of thought regarding categories of male infertility based on intracellular and extracellular features of semen and sperm, explore the prevalence of the various categories of male factor infertility, call attention to the lack of standardization and universal application of advanced sperm testing techniques beyond semen analysis, and clarify the limitations of standard semen analysis. We also call attention to the variability in definitions and consider the benefits towards undetermined male infertility if these gaps in research are filled.
Graphical abstract
中文翻译：
对于未确定的男性不育症缺乏可信的诊断工具
精液分析是评估男性不育症的基石，但它并不完善且不足以诊断男性不育症。因此，大约 20% 的不育男性患有未确定的不育症，该术语涵盖了根本原因未知的男性不育症。未确定的男性不育症包括两类：(i) 特发性男性不育症——精液分析异常且异常原因未知的不育男性；(ii) 原因不明的男性不育症——精液分析“正常”但由于不明原因而无法受孕的男性。原因。由于缺乏对一般精子缺陷（例如数量、活力、形状、活力）的频率的了解，对未确定的不育症男性的治疗受到限制。此外，缺乏可信赖的定量和预测性诊断测试来观察精子内部，以量化 DNA 损伤、RNA 异常、中心粒功能障碍或活性氧等缺陷，从而发现根本原因。为了更好地治疗未确定的男性不育症，需要对精子缺陷的频率进行进一步研究，并且必须开发评估细胞内精子成分的可靠诊断工具。本综述的目的是基于精液和精子的细胞内和细胞外特征，独特地创建关于男性不育类别的思维范式，探讨各种类别男性因素不育的患病率，引起人们对缺乏标准化和普遍性的关注。应用精液分析之外的先进精子检测技术，并阐明标准精液分析的局限性。 我们还提请注意定义的可变性，并考虑如果填补这些研究空白，对未确定的男性不育症的益处。
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