Infertility affects nearly 8 – 10 % of all married couples worldwide. Both male and female partners may have some problem responsible for infertility. In nearly 30% the female alone is involved, in another 30 % only male is involved, in another 30 % both the partners may have some problem and in 10 % no cause may be found. Among the problems of sperms of males azoospermia or no sperm in the ejaculate is seen in about 5 % – 10 % of infertile males. Generally it comes as a shock because there are no signs and symptoms of this condition and sexual function is not affected. From treatment point of view, azoospermia can result because of following problems.

• Testicular atrophy or damage to the testes – In vast majority of cases the cause is not known. Various environment and dietary factors, addictions etc. have been implicated but direct proof is lacking. A history of undescended testes, trauma to the testes or mumps orchitis may be available in some cases.
  There is no medicine which can improve this condition. Intracytoplasmic sperm injection (ICSI) i.e. test tube baby technique can be tried in some cases where even few sperms are present in the testes. Otherwise insemination with donated spermatozoa is also a very good technique.
• Obstructive Azoospermia – There are very long tubes which transport the sperms from testes to outside at the time of ejaculation. These tubes also could get blocked due to some infection, operation (sterilization operation) or may be absent by birth. In these cases sperm production inside the testes continues. In these cases again no medicines can help. Operation may help in few cases of sterilization reversal and very small blocks. Otherwise test tube baby technique i.e. ICSI with sperm taken out from the testes with help of a fine needle has very good chances of success.
• Hormonal deficiency– There are very rare cases where sperms are not produced because of deficiency of hormones. These cases can be treated with hormone injections with good results. However, such cases are seen very occasionally.
• Ejaculatory dysfunction – These are the cases where due to some sexual dysfunction ejaculation does not happen e.g. cases of impotence, duct blockage, spinal cord injury or retrograde ejaculation. In these cases also ICSI with sperms taken from testes is highly successful.

ICSI with testicular sperm is a highly successful technique and success depends upon the quality of spermatozoa. However, these sperms can’t be utilized for IUI etc.