Clinical azoospermia is diagnosed by the absence of spermatozoa on more than 3 semen examinations, and semen must be microscopically examined after centrifugation. Medically, azoospermia is divided into obstructive azoospermia and non-obstructive azoospermia. The distinction is mainly made by: 1. palpation by male physicians (testicular size, epididymis/vas deferens development) 2. laboratory examination of semen volume, pH of semen, seminal plasma biochemistry (fructose, a-glycosidase), sex hormone examination (Fsh, Lh, T, PRL, E2), autosomal karyotype analysis, Y chromosome microdeletion 3. transrectal seminal gland ultrasound, seminal vesicle microscopy, nuclear magnetic 4. past medical history, especially bilateral hernia at an early age. Especially bilateral hernia repair in early childhood If obstructive azoospermia is suspected, such as full epididymis, presence of vas deferens, low semen volume, acidic semen Ph value, low fructose value in seminal plasma biochemistry, negative a-glycosidase, and basically normal sex hormone examination. For patients who do not have the above medical history or are basically judged to have non-obstructive azoospermia, and whose testicles are above 6ml in size and no chromosomal abnormalities are seen, we recommend to perform “testicular puncture biopsy” directly, and the sperm found during the operation can be frozen and preserved for single sperm microinjection during IVF later. If there is no sperm in the puncture, then we recommend “microscopic testicular dissection for sperm retrieval”, which has a success rate of 40-70%, as the inclusion criteria vary from center to center. For patients with small testicular volume, less than 6 ml, and no chromosomal abnormalities, we recommend direct “microscopic orchidotomy”, which has a higher success rate of sperm retrieval by expert communication. For patients with Creutzfeldt-Jakob syndrome, chromosome 47XXY or chimerism, which was thought to be untreatable until a few years ago, the development of microsurgery has enabled some patients to obtain sperm through “microscopic orchidopexy” and to successfully conceive their loved ones through the combination of IVF technology. In patients with microdeletions of the Y chromosome, the probability of finding sperm is very low if the deletion is at the a or b locus, so treatment can be abandoned and donor sperm can be used for conception. It is very painful to see no sperm in semen examination, and it is necessary to go to the regular hospital for consultation and treatment, detailed consultation, comprehensive laboratory tests, and finally choose different surgical methods combined with IVF to help conceive, and there is still a great hope to be a father. So to see the hope, we work together.