Azoospermia is the absence of spermatozoa in the neat semen sample and the centrifuged resuspended semen pellet on more than one occasion. Around 10–15% of infertile men are diagnosed to have azoospermia either due to obstructive or non-obstructive causes. A meticulous history and physical examination may reveal the cause for azoospermia in many men. Laboratory investigations help substantiate the findings or diagnose conditions that may not be revealed during a physical exam. Azoospermia due to hypogonadotropic hypogonadism is the only condition that is amenable to medical management. Surgical spermatozoa retrieval and assisted reproduction with intracytoplasmic spermatozoa injection have helped many couples achieve biological parenthood.