When a man is diagnosed with azoospermia, it is like a bolt from the blue. When a man is diagnosed with azoospermia, it’s a shock. How can the roots of life be preserved if the bloodline can no longer continue? Azoospermia is a condition in which semen is ejaculated during sexual intercourse, but no sperms are found in the semen. Azoospermia is not rare and accounts for about 1 to 2 percent of the total population, which means that about one in 50 to 100 men may have azoospermia. At least 30 million men worldwide have been diagnosed with azoospermia. The serious reality of infertility is excruciatingly painful for the patient, seriously affecting his family harmony and quality of life, and even love broken. How to make azoospermia into sperm? Realizing something from nothing is the dream of male physicians all over the world. Azoospermia is categorized into 3 types ①The most common is testicular azoospermia, due to the disease of testis itself, resulting in the failure of spermatogenic tubules in the testis, unable to produce sperms. ② The second is congenital abnormality or obstruction of the testicular sperm output ducts, resulting in obstruction of sperm discharge, which is a disease of the spermatogenic ducts. ③ Less common is the third type, which affects the function of the testicular spermatogenic tubules due to abnormal invention of reproductive hormones caused by hypothalamic pituitary diseases. For azoospermia caused by the latter two problems, our male physicians are fully capable of creating something out of nothing. Testicular and epididymal The first trick to create something out of nothing: injection of sex hormones When a patient with azoospermia, the test of sex hormones reveals that the levels of gonadotropins (FSH, LH) and testosterone (T) are relatively low, i.e., the so-called hormone triple-low, or accompanied by a decrease in the sense of smell in the nose, then it is considered to be the hypothalamus secreting hormonal disorders leading to azoospermia, and the treatment of this kind of azoospermia is medication, and it can be taken as the gonadotropin ( HMG (HMG) intramuscular injection or pituitary hormone pump treatment for half a year, about 50% of such patients can realize “nothing from nothing”, after the treatment of sperm appeared, semen volume at the same time gradually increased, beard, throat knots, and armpit hair gradually appeared. After the appearance of sperm, sperm freezing can be started immediately, or the patient can prepare for childbirth. The second trick: micro and minimally invasive surgery vas deferens recanalization If the testicular size is found to be normal when the examination is given for azoospermia, and the test for sex hormone pentameter is also normal, then it is considered to be due to obstruction of the vas deferens. The obstruction can be in the testicular network, epididymis, vas deferens, or the ejaculatory ducts and posterior or anterior urethra. For this type of obstructive azoospermia, our physicians are more than capable of creating something out of nothing. It is possible to rebuild the male sperm transport pipeline through non-invasive or minimally invasive surgery. (1) If physical examination reveals normal testicles/enlarged epididymis, normal semen volume, normal hormones, and ultrasound confirms obstruction, consider epididymal obstruction, and choose microsurgical vas deferens-epidididymal access surgery, which can achieve 60%~80% access rate, and the natural pregnancy rate after surgery can reach 30%~40%, and the cost is one-third of IVF. (2) If you have had vasectomy or hernia surgery in the past, and you consider vasectomy obstruction, the rate of vasectomy re-opening surgery can reach 90%~99%. If high vasectomy obstruction, laparoscopically assisted recanalization surgery is needed, which is better, with small incision, less trauma, and easy to find the two severed ends of the vas deferens. (3) If the ejaculate volume is very low and thin, there may be ejaculatory duct obstruction or congenital lack of development of seminal vesicle glands. Transurethral ejaculatory vasotomy is the first consideration. Of course, part of the obstruction is due to the absence of vas deferens and seminal vesicles, then consider testicular or epididymal sperm retrieval after IVF. The third trick to create sperm from nothing: micro sperm extraction and stem cell production of sperm When the testicular vas deferens factor is ruled out, and also ruled out hypothalamic pituitary disease, this part of the patient is testicular azoospermia. (1) For this part of the patients, we should not rush to surgery, and give the patients more chances to recover. Recent studies have found that certain drugs such as letrozole, carnitine, PDE5 inhibitors, and Chinese medicine diagnosis and treatment have some value, and repeated semen centrifugal testing sometimes reveals active spermatozoa. Reproductive centers should carry out sperm freezing and thawing as soon as possible, and freezing and thawing can also be an option for inactive live sperm. (2) When the treatment is six months and repeated semen analysis centrifugal testing is still spermless for six to eight times, surgical sperm extraction can be considered. Finally, a three-step sperm retrieval technique is adopted, namely: ① testicular puncture technique is carried out first; ② testicular 5-point biopsy technique is chosen if there is no sperm; ③ micro sperm retrieval technique is considered if it is still not found. Sperm retrieval technique can be chosen 1~2 days before the day of egg retrieval, or establish a new technique of sparse or single sperm cryopreservation. (3) When no spermatozoa are found in the operating room, testicular tissue should not be discarded and continue to be carefully cultured; spermatozoa can be found in about 5%~10% of the patients in culture or multiple observations. Once found, it is immediately frozen and preserved. (4) Of course, now that medical science is advancing, the manufacture of sperm cells from stem cells is no longer a myth or legend. The seed cells of choice are spermatogonial stem cells in the testes, induced pluripotent stem cells made from skin, embryonic stem cells and so on. Nowadays, medical advances have been made and this experiment has been done on animals, but experimentation on humans is still in its infancy, due to the use of certain genetically modified techniques, so the safety and efficacy of obtaining spermatozoa.