Progress in medically assisted procreation has made it possible to obtain an embryon with a single spermatozoid or even a single spermatid. But such advanced technology must not overshadow the basic principles of patient management since there are many other medical or surgical possibilities for improving male fertility. Although the physiological mechanisms leading to azoospermia are relatively well understood, many questions remain as to the origin of oligo-asthenoteratospermia. Varicocela had been incriminated by many authors: in 25% of the cases, surgical care is followed by pregnancy. Other factors including autoimmunity, infection, environment and drugs also have an effect. Careful history taking can identify the main causes of male infertility before the problem of procreation occurs and in cases of definitive azoospermia the principles of management are relatively simple. The true problem is the fact that new techniques such as in vitro fertilization have acquired popularity in the general population but cannot be accepted as the gold standard by the medical community. It must not be forgotten that these artificial techniques cause a major psychological trauma to the couple and can lead to difficult situations (multiple pregnancies, extra embryos) with no totally satisfactory solution.