Medical management of male infertility has traditionally involved therapies directed toward manipulation of the hypothalamic-pituitary-gonadal axis.The medications available currently are essentially identical to those utilized decades ago.Moreover,these agents require that the infertile patient can produce at least a small number of functional sperm.As conveyed by Dr.Ring et al.1 in the accompanying manuscript,a significant percentage of male infertility is defined as “idiopathic” suggesting a specific diagnosis was impossible.Moreover,given that a subset of these patients is postulated to have unrecognized genetic etiologies,the notion of targeted medical treatment becomes even more problematic.Many patients are thus placed on empiric therapy in hopes of augmenting baseline spermatogenic function.While this may prove fruitful in patients with intact spermatogenesis,the true challenge lies in the treatment of the azoospermic patient due to testicular failure.