Male infertility: a critical review of pharmacologic management.

INTRODUCTION: Male factor infertility contributes partially and solely to the problem of childlessness in around 50% of the cases. Unfortunately, 30 - 50% of the etiologies of male infertility are unknown and therefore, no specific therapy can be instituted. Evidence-based medical therapy for male infertility is an attractive research area where a large number of clinical trials, controlled and uncontrolled, using different types of medications have been conducted yielding variable results and outcomes. AREAS COVERED: In this review, we summarize and evaluate the most important and most recent information pertaining to the use of different medications in male infertility and assign level of evidence to these medications. An extensive literature search was performed using the search engines: Pubmed, Science-direct, Ovid and Scopus. EXPERT OPINION: Male infertility represents a very challenging area of clinical medicine. Many different types of medications have been tried and very few have had satisfactory results. There is a huge need to advance and develop andrologic diagnostic techniques, focusing on the metabolomics and proteomics of the sperm, seminal plasma, and testicular tissue. Clarification of the causes of idiopathic male infertility and the discovery of novel molecular targets will help guide future innovative development of new pharmacologic agents.