According to WHO semen analysis standards, spermatozoa were searched for after 2 or more centrifugations, qualitative fructose testing, transrectal ultrasound, karyotype analysis, and hormone examination in patients with azoospermia. After examination, for patients with high suspicion of vas deferens and/or epididymal obstruction, scrotal exploration is firstly recommended, and microsurgical anastomosis of the vas deferens or vas deferens epididymal duct is performed according to the obstruction. For patients who refuse surgery or fail to undergo surgery, diagnostic epididymal and testicular puncture is feasible, and after successful puncture, semen freezing and ICSI treatment are performed. For those who fail puncture, further testicular dissection for sperm extraction can be performed. For patients with irreversible obstructive azoospermia such as bilateral vas deferens and congenital dysplasia, ICSI treatment is firstly recommended. Diagnostic percutaneous epididymal and testicular puncture and Y chromosome microdeletion detection are routinely performed before surgery, and preimplantation diagnosis is considered for those with abnormal Y chromosome microdeletion detection. For patients with non-obstructive azoospermia, chromosome nuclear analysis and Y chromosome microdeletion testing can be performed first. For patients with YqAZFa, YqAZFb or YqAZFb+c deletions and other chromosomal abnormalities, it is recommended that no further treatment should be performed and AID should be selected directly. Patient Li *, male 26 years old, primary infertility, was found to be azoospermia on routine semen examination, and testicular biopsy showed that primary and secondary spermatocytes were visible in the varicocele, and no spermatocytes or spermatozoa were seen. The results of sex hormone six did not show any significant abnormalities. The male examination showed normal size and shape of both testes, no pressure pain and hard nodes, and mild varicose veins in the left spermatic cord. Chromosomal examination has been performed and the results have not been reported. If there is no abnormality in the chromosomal examination, please advise further treatment plan.