Medical treatment for idiopathic male infertility: is it curative or palliative?

Medical treatment of disorders of sperm production and function remains an important goal despite major advances in assisted reproductive technology. Effective treatments exist for genital tract obstruction, gonadotrophin deficiency, sperm autoimmunity, coital disorders and some impairments caused by toxins or illness. However, the majority of men seen for reduced sperm production or function do not have these conditions and the empirical treatments used in the past are probably ineffective. New therapeutic approaches derived from research on the causes and mechanisms of testicular dysfunction are needed and their curative effects must be established by well-designed controlled clinical trials.