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			Concern Treatment Pregnancy Experiences Concern Evaluating Your Fertility Understanding Fertility Maximise Your Fertility Infertility: An Introduction Infertility in Females Infertility in Males Sperm Disorders Absence of Sperm Reduced Sperm Sperm Abnormalities Antisperm Antibodies Anatomical Implications of Infertility Questions to Ask Your Doctor		Absence of Sperm Azoospermia: Absence of Sperm   Azoospermia is the absence of spermatozoa in the semen or the failure of formation of spermatozoa. It can arise as a result of primary testicular failure, obstruction or previous vasectomy. Complete azoospermia signifies infertility. Common causes of azoospermia include: Primary testicular failure    This may be due to genetic defects, undescended testes, physical injury to the testes or mumps occurring after puberty. Often the cause is unknown. Patients with primary testicular failure usually have small, soft testes and a grossly elevated plasma FSH. Although undescended testes may be surgically corrected, the chance of restoring fertility is remote. Obstruction    This is the second major cause of azoospermia. It is sometimes amenable to surgery and surgical exploration can be undertaken in patients with normal size testes and with a normal FSH. The results of surgery depend on the location of the blockage and there is at best a 50% success rate in those patients with an obstruction in the cauda epididymis due to gonorrhoea. Sexually transmitted diseases may cause epididymitis and lead to blockage of the ductal system, resulting in permanent azoospermia. Obstructive azoospermia can also be due to agenesis (absence) of the epididymis and other parts of the ductal system, including the vas deferens. Some of these cases seem to be of genetic origin. Congenital bilateral agenesis of the vas deferens is found in most patients with cystic fibrosis. It has been shown that point mutations of the cystic fibrosis gene may be present in at least two-thirds of men with isolated bilateral agenesis of the vas deferens without any other symptoms of cystic fibrosis. This means that men with agenesis of the vas deferens who produce sperm, and are thus suitable for ART, must be counselled about the risk of cystic fibrosis in any child produced. Previous vasectomy    This is an increasingly common cause of azoospermia in Western countries and in countries such as India where it is a favoured method of contraception. Absence of germ cells    In many men with azoospermia, the seminiferous tubules contain only Sertoli cells. This can result from numerous causes, including cytotoxic drugs, irradiation or due to factors present during foetal life. However, in most cases the aetiology is unknown.
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