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The management of oligoasthenospermia has undergone changes in this era of assisted reproductive techniques (ART), bringing hope for previously untreatable cases of oligospermia. However, the overenthusiastic use of ART has deprived some patients of primary treatment for their disease. Oligoasthenospermia is the most common identifiable anomaly found in semen analysis, and it can be treated or improved in many cases. The patient deserves a chance to be evaluated and helped, and a specific treatment should be offered to achieve pregnancy whenever available. Where this is not possible, suitable candidates should be selected for empirical medical treatment. The aim of pharmacological treatment is to improve the sperm concentration and the fertility potential of sperms. This twofold approach is helpful in both natural and assisted fertilization. ART are, however, an excellent alternative when other therapies fail.