The incidence of infertility in China is about 10-15%. The male factor accounts for about 40% of the cases, the female factor accounts for about 40%, both factors account for about 10% to 20%, and 10% to 15% have unknown causes (i.e., idiopathic infertility). Male infertility is the result of multiple diseases and/or factors, usually classified as pre-testicular, testicular and post-testicular depending on the disease and the interfering or affecting reproductive link, but still a significant number of patients cannot find a clear cause. When it comes to the treatment of male infertility, the first thing that comes to many people’s mind is taking medication, not only western medicine, but also not a few of those considering receiving herbal treatment. But some of the diseases that lead to infertility are not effective, at this time, perhaps more people will immediately think of turning to assisted reproductive technology, commonly known as “test tube baby”. Despite the rapid development of assisted reproductive technology, it should not be the first choice considering economic factors, reproductive risks, cost-benefit comparison studies, possible ethical issues, risks of multiple births, and disturbance to female physiology. What to do? Many people may shake their heads if we say that male infertility can still be treated surgically, what is the situation? The main surgical treatment options available for male infertility are the following: 1. Varicocele surgery: Varicocele is a common cause of male infertility. Surgery is the main effective means of treating varicose spermatocele. Studies have shown that one year after surgery can have about 40% natural pregnancy rate of the spouses and two years pregnancy rate can be up to 70%. Interventions for varicocele repair include interventional techniques (cis or retrograde) and surgical treatment. Surgical interventions include traditional transinguinal route, retroperitoneal route, transinguinal subserosal route spermatic vein ligation, microtechnical inguinal route or subserosal route spermatic vein ligation, laparoscopic spermatic vein ligation, etc. According to some information, microscopic spermatic vein ligation is the most ideal treatment at present and is called the “gold standard”. 2.Vasectomy anastomosis: microsurgical vasectomy is feasible for proximal obstruction after vasectomy, i.e. vas deferens-vasectomy. In case of limited obstruction of the scrotal segment of the vas deferens caused by inflammation, anastomosis with excision of the obstructed segment can also be done. Bilateral absence of the vas deferens due to injury from a hernia or testicular descent fixation surgery in childhood can be treated with assisted reproductive technology, or with a vas deferens anastomosis. There are several methods of vasectomy to choose from, the simplest being the single-layer anastomosis technique or the modified single-layer anastomosis technique. The advantage of this technique is that it is simple to operate, requires low microscopic skills and is easy to promote, but the success rate is lower than that of the more advanced multi-layer anastomosis technique, of which the success rate of the innovative fine microdot multi-layer anastomosis technique of the Cornell Institute for Reproductive Research can reach 99.5%. 3.Vasectomy epididymal anastomosis: About 10-15% of male infertility patients are caused by obstructive azoospermia, and its treatment has a very important status in male infertility. As the most effective treatment for epididymal obstruction, vasovaginal epididymal anastomosis is of great value in the treatment of obstructive azoospermia. In another case, if no spermatozoa are found in the vas deferens fluid near the epididymis when a vasectomy is performed, but a toothpaste-like mucus is found, this is an indication of secondary epididymal obstruction caused by long-term ligation, and an epididymal vas deferens anastomosis is required instead of the traditional vas deferens anastomosis. In 1978, Silber in the United States pioneered the use of microsurgical techniques to perform end-to-end vasovasovaginal anastomosis, and in 2000, Marmar invented the transverse double-needle overlay technique, based on many previous improvements. The new anastomosis technique is similar to the traditional method in terms of semen quality and pregnancy rates, with lower restenosis rates, making this extremely challenging anastomosis simple to perform. PT Chan of the Cornell team modified the transverse double-needle sleeve technique to a longitudinal double-needle sleeve technique, which is now considered one of the preferred methods for vasoductal epididymal anastomosis. 4.Ejaculatory duct obstruction: Azoospermia or severe oligospermia caused by obstruction of the ejaculatory duct orifice can be treated by spermoscopic exploration or transurethral ejaculation ductotomy/ejaculatory duct cystectomy, etc., which can result in spontaneous pregnancy in the spouses of some patients. Microscopic sperm retrieval for non-obstructive azoospermia: For azoospermia caused by low or impaired spermatogenesis but not obstructive factors, due to the possibility of “focal spermatogenesis” in the testes, the small testes can be cut open to search for sperm with the aid of microscopy, which can not only protect the testicular tissues to the maximum extent, but also find the scattered sperm with greater precision. of spermatozoa. In technically mature centers, the sperm discovery rate of this exploration can reach 60%-70%, and then combined with assisted reproduction techniques, ultimately enabling more male infertility patients to obtain real biological offspring of their own. 6, erectile dysfunction: for infertility secondary to failure of sexual intercourse due to erectile dysfunction, the first choice of first-line drug therapy, or second-line negative pressure suction, penile cavernous body drug injection, etc., for patients with poor results or intolerant, and unwilling to directly use assisted reproductive technology, can be based on the cause, the use of penile vascular surgery or penile support implants. For sexual intercourse disorders due to penile curvature deformity, the 16-point technique can be used to correct penile curvature. For example, for the same patient with varicocele, some doctors may recommend surgery, others may recommend medication, and the fertility center doctors may directly recommend assisted reproduction. Who is right? Who is right? It may be a matter of analysis rather than generalization. Ultimately, the choice of treatment depends on maximizing the benefits for the patient rather than on the physician’s preference. We should not advocate surgical treatment because we are good at surgery, nor should we give patients medication because we don’t want to do surgery, nor should we directly treat them with assisted reproduction without any choice. Of course, these techniques can sometimes be used in combination. For example, a patient with non-obstructive azoospermia who is treated with medication to improve the chances of obtaining sperm by microscopic techniques and then through assisted reproductive techniques, the patient can eventually obtain offspring is the perfect combination of the three. Whether the choice is between medication or surgery, or assisted reproductive technology, the fundamental principles of maximizing patient benefit and the right to be fully informed should be followed.