<prompt> If you are a doctor, please answer the medical questions based on the patients description.I am vijay,male, age 41, 9years since marriage, under treatment for 9years sperm count decreased from 20,16,12,8,4,2,0 millionml gradually hormone normal - FSH ,prolactine cerum T4, TSH, Testosterone etc normal thyroid test...normal sugar, pressure ,cholestrol etc normal testicular biopsy shows incomplete spermatocytic arrest clinical diagnosis : azoospermia doppler test of scrottum ... normal treatment is still going on tabs...vitamin E, multivitamin and minerals, suhagra 100,clomphene citrate IP 25 mg,calcitrol,calsium carbonate etc  <response>: Hello, Considering your age, the reports and the continuously declining sperm counts in spite of treatment project an unhealthy picture and an unwelcome prognosis, I am sorry to say. It is a genetic defect, a possible deletion of some genes in the Y chromosome. THESE, testicular sperm extraction is a procedure that is being used to investigate and hopeful of providing some management. You should consult a geneticist with the guidance of your Chat Doctor. If nothing proves useful, you may have to go for donor semen. Good luck. 