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1 Introduction Male infertility represents a significant global health burden, contributing to nearly half of all infertility cases among couples ( Conventional semen analysis focuses on sperm concentration, motility, and morphology, yet these parameters do not capture the underlying molecular disturbances that compromise fertilization potential ( 2 Idiopathic male infertility: a clinical and conceptual overview 2.1 Definitions and diagnostic challenges of idiopathic male infertility IMI is broadly defined as the inability to conceive after at least 12 months of unprotected intercourse, in the absence of identifiable female factors, where standard diagnostic evaluations in men fail to reveal a clear etiology ( Diagnostic pathway for male infertility typically includes semen analysis, hormonal profiling, scrotal ultrasonography, karyotyping, and Y-chromosome microdeletion testing ( Importantly, idiopathic infertility is not a true diagnosis but a reflection of the diagnostic gap in current practice