Azoospermia is a medical condition where there are no sperm in the ejaculate. It can be obstructive, where there is a blockage preventing sperm from entering the ejaculate, or non-obstructive when it is due to decreased sperm production by the testis. Azoospermia is a major cause of male infertility, and around 10% of infertile men and 1% of all men have azoospermia. The causes of azoospermia can be an obstruction or blockage, hormonal problems, ejaculation problems, or issues with testicular structure. Blockages occur most commonly in the epididymis, vas deferens, and ejaculatory duct. A detailed evaluation should be done in patients with azoospermia, including a complete medical, sexual, and surgical history of the patients. The evaluation includes a detailed history regarding trauma to the genital organs, drug allergies, medication history, chemotherapy, pesticide, and radiation exposure. The treatment of azoospermia depends on the underlying cause, and hormonal problems and obstructive causes of azoospermia are usually treatable, and fertility can potentially be restored. If testicular disorders are the cause, it’s important to note that many causes of azoospermia can be reversed.