Despite advancements in assisted reproductive technology (ART), the treatment of idiopathic male infertility (IMI) remains suboptimal. Current management is largely empirical, relying on small observational studies rather than robust clinical trials and strong evidence. Among the available options, Follicle-stimulating hormone (FSH) has shown potential in improving sperm parameters and achieving clinical pregnancies in IMI cases. This review aims to update recent findings on the efficacy of FSH therapy in IMI and explore the potential application of the novel APHRODITE criteria for male infertility patients undergoing hormonal treatment.

A comprehensive literature review was conducted up to December 2024, focusing on studies evaluating the effects of FSH on semen parameters, sperm DNA fragmentation (SDF), and pregnancy outcomes (natural or ART-mediated) in IMI patients. Recent clinical guidelines for hormonal treatment of IMI were also reviewed. Additionally, the APHRODITE criteria were analyzed for their potential to classify infertile males systematically and propose a structured approach to hormonal treatment.

Studies have demonstrated significant improvements in semen parameters, including sperm concentration, total count, motility, and reduced SDF following FSH therapy. Pregnancy rates after treatment were also promising. The common dosage of 150 IU administered every other day for three months showed efficacy, while higher doses and prolonged treatment duration yielded even greater benefits. The APHRODITE criteria present a systematic framework for managing IMI patients (group 2), offering a structured approach to candidate selection and treatment planning.

FSH therapy appears to be a viable option for improving semen parameters and pregnancy outcomes in IMI. However, current evidence is limited and requires further research to identify optimal candidates and protocols. The APHRODITE criteria emerge as a potential standardized framework to guide clinical application and support future research in the management of IMI.