Previously, pharmacologic treatment was empirically and often irrationally for infertile males. As a result of the technological advance provided by intracytoplasmic sperm injection (ICSI) in 1992, the evaluation and treatment of the infertile male has changed significantly. Many men who were previously thought to be irreversibly infertile have the potential to initiate their own biologic pregnancy. However, not all men having impaired semen parameter are ideal candidates for ICSI for numerous reasons including a lack of addressing the underlying problem causing the male infertility, unknown genetic consequences, and cost-effectiveness issues. If pharmacologic therapy is going to be used, it should be employed for a 3- to 6-month period so that at least one full spermatogenetic cycle will be incorporated. Advances in pharmacological and hormonal research in the area of male reproduction and improved methods of reproductive technologies may be combined with medical therapy to improve a couple's fertility outcome.