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Azoospermia is the term used when there is a complete absence of sperm in the ejaculate. This represents the most severe form of male infertility. About 8% of men who present to our centre suffer from azoospermia, These men require careful and expert assessment. A few of them have reduced hormones and will respond well to hormonal treatment. Most, however, will require a minor surgical procedure to obtain sperm from the testis (TESA) or by needle aspiration through the epididymis (PESA) or a small piece of tissue can be taken by miniature cut (Biopsy) especially if there is only immature form of sperm present (spermatide) and then use them for ICSI.