The development of testicular sperm retrieval techniques and the maturation of intracytoplasmic single sperm injection (ICSI) have made it possible for patients with non-obstructive azoospermia to have sired offspring. However, conventional sperm extraction can only successfully retrieve sperm for a small percentage of patients, so how to improve the sperm acquisition rate of sperm extraction has become the focus of current research. Recent studies have shown that testicular microsperm extraction may have advantages over traditional sperm retrieval. Azoospermia is defined as the failure to find spermatozoa on three consecutive occasions after microscopic examination of ejaculated semen after centrifugal sedimentation. Cases of non-ejaculation and retrograde ejaculation are excluded. Azoospermia is divided into: obstructive azoospermia (the testes have spermatogenic function, but the sperm produced cannot be excreted due to blockage of the vas deferens and congenital vas deficiency) and non-obstructive azoospermia (the testes themselves are dysfunctional, also known as primary azoospermia). There are many methods of sperm extraction available, the more common ones being fine needle aspiration, open testicular biopsy and testicular microsperm extraction. In addition to traditional fine-needle aspiration, some scholars have performed multiple, multi-site “map” punctures of the testes in the equatorial plane and at the poles to increase the rate of sperm acquisition, called map-based sperm retrieval. The combination of testicular sperm retrieval and intracytoplasmic sperm injection (ICSI) has made it possible for patients with non-obstructive azoospermia to have healthy, related offspring. However, open testicular biopsy in testicular sperm retrieval is less precise in its localization. In 1999, Schlegel first reported microscopic testicular sperm retrieval, in which the operator opens the white membrane along the equatorial surface of the testis, looks for full, opaque spermatogenic tubules under a 20- to 25-fold operating microscope, cuts them down, and searches for suitable sperm. On the one hand, these fuller, opaque germinal tubules are more likely to contain sperm; on the other hand, microscopic manipulation also allows for better identification of the submembranous vessels to reduce the risk of blood flow obstruction. Years of practice have shown that although testicular sperm retrieval techniques are more effective and safer than traditional sperm retrieval methods, they are still only successful in some patients with non-obstructive azoospermia. After sperm retrieval by microscopic sperm extraction, the retrieved sperm need to be frozen in a human sperm bank for intracytoplasmic single sperm injection (ICSI) after egg retrieval by the female partner, which theoretically reduces the number of sperm needed for insemination to one and has a fertilization rate of 60% to 80%. Many studies have shown that the success rate of ICSI is independent of the source of sperm parameters. Sperm with incomplete acrosomes, inactive sperm, and even sperm with a head and no tail may be able to fertilize an oocyte by ICSI. Thus, patients with non-obstructive azoospermia (including congenital varicocele syndrome) can also have their own offspring using sperm obtained from the testes.