Evidence-based Approaches to Male Infertility: Current Standards and Future Directions

About 13–15% of couples have male infertility, a multifactorial condition that contributes to roughly half of all reported cases of infertility globally. Its aetiologies include genetic, endocrine, anatomical, infectious, immunological, environmental, and idiopathic causes. Genetic abnormalities, dysregulation of the hypothalamic-pituitary-gonadal axis, varicocele-associated oxidative stress, previous cryptorchidism, genital tract infections, and antisperm reactions are the main causes of its pathogenesis, which disrupts spermatogenesis and sperm transport. Oxidative stress and hormonal imbalance are common routes shared by environmental pollutants, obesity, heat exposure, and lifestyle variables. Dopamine agonists for hyperprolactinemia; gonadotropin therapy with hCG and FSH in hypogonadotropic hypogonadism; varicocele repair in men with palpable varicoceles and abnormal semen parameters; avoidance of exogenous testosterone or anabolic steroids in men pursuing fertility; and selective oestrogen receptor modulators like clomiphene and tamoxifen in idiopathic oligozoospermia with suboptimal testosterone. Although there is still little data based on guidelines, antioxidants, including CoQ10, L-carnitine, and vitamins C and E, may lessen oxidative stress. The results of severe oligozoospermia and azoospermia have been transformed by assisted reproductive technologies like IVF and intracytoplasmic sperm injection, which are complemented by surgical methods, including orchiopexy, repair for blockage, and sperm retrieval procedures. Probiotic manipulation of the gut-testis axis, stem cell transplantation, immunomodulators, and nutraceuticals are emerging topics that hold promise for the future. To maximise reproductive results for men and couples, management ultimately calls for a customised, evidence-based, multidisciplinary approach that incorporates established therapies, emerging research, and guideline recommendations.