Absence of sperm in the ejaculate fluid.

There are two forms of azoospermia:

• Obstructive azoospermia: sperm is created normally but there is an obstruction preventing normal transport of the sperm through the ducts. The obstruction can be caused by an infection, trauma, inguinal surgery, agenesis of vas deferens, prior vasectomy, etc.
• Secretory: there is a low or lack of sperm production in the testicles. This is commonly caused by partial or total testicle removal, orchitis, trauma, inguinal surgery, cryptorchidism, genetic abnormalities, chemotherapy, radiotherapy, etc. but most of the times the cause of a testicular failure is unknown. In some cases sperm is produced in some areas of the testicles and it is possible to retrieve it by performing a testicular biopsy and used it for IVF-ICSI.

The reproductive prognosis greatly varies from one form of azoospermia to the other, obstructive azoospermia being the one with better prognosis.

Investigations to determine the type of azoospermia typically include a physical examination, a complete medical history, a sperm analysis and more importantly a blood test to check the FSH and Inhibin B levels as well as a testicular biopsy.

A particular case of azoospermia is the absence of vas deferens (agenesis). In these cases it is important to undertake a cystic fibrosis test. There is evidence that patients who are carriers of one of the cystic fibrosis gene mutations often have agenesis of vas deferens. The cystic fibrosis is the most common autosomal hereditary disease in our population.

The presence of an abnormal karyotype and Y chromosome microdeletion may be genetic causes of secretory azoospermia. These two tests are very helpful to make an accurate diagnosis and offer appropriate genetic counseling when needed.

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The causes of male infertility are mainly related to the low quality of semen..