Dr. Hanif warmly welcomes you! Thanks for consulting at my virtual clinic. I have carefully worked through your case, and can well realize your health worries. Being your physician, I want to assure, I will take care all of your medical concerns. It may be caused either by obstruction to the passage of the sperms down the tract (Obstructive Azoospermia=It may be due to infections or other injuries in life or it may congenitally be present due to malformation of the reproductive tract structures anatomically) or it may be due to inadequate production of sperms (Non-obstructive Azoospermia=May be due to sexually transmitted diseases like gonorrhea, HIV). Ejaculation defects may also lead to semen without sperms. One of them most commonly seen is Retrograde Ejaculation in which sperms instead of coming out go back and land to urinary bladder. Causes may be certain medications, diabetes and bladder and urethra surgery. Genetic disorders like Cystic Fibrosis is also associated to the male infertility. FSH and Testosterone hormones also affect such infertility problems. scrotal veins problem also affect male infertility. Hope I answered all of your questions. Please don t forget to add your precious positive feedback to help me able to assist you better in future too. Have a wonderful time ahead. Keep in touch for a follow-up too to let me know if you have any doubts & need further assistance. I am available 24/7 for your help. Have a blessed time ahead. Regards! DR. MUHAMMAD HANIF USA