The incidence of infertility in China is about 10-15%. The male factor accounts for about 40%, 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 and is usually classified as pre-testicular, testicular and post-testicular depending on the disease and the interfering or affecting reproductive link, but there are still a significant number of patients for whom no clear cause can be found. 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 there are few who consider 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 resorting to assisted reproductive technology, commonly known as “in vitro fertilization”, despite the rapid development of assisted reproductive technology, but taking into account economic factors, reproductive risks, cost-benefit comparison study results, possible ethical and moral issues, multiple births Despite the rapid development of assisted reproductive technology, it should not be the first choice due to economic factors, reproductive risks, comparative cost-benefit studies, possible ethical and moral issues, risks of multiple births, and disturbance to the 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? According to Professor Li Shihua, a leading American microscopic male specialist, more than 70% of male infertility can be treated by microsurgery or combined assisted reproductive techniques (MIM/ IVF/ ICSI). The following are the main types of surgical treatment options available for male infertility: 1. Varicocele surgery: Varicocele is a common cause of male infertility. Surgery is the main means of treating varicocele. 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, and laparoscopic spermatic vein ligation. It has been suggested that microscopic spermatic vein ligation is the most ideal treatment modality and is called the “gold standard”. In 2004, the author, referring to the surgical video library of the Cornell Institute for Reproductive Research and the seventh edition of Campbell’s Urological Surgery written by its academic leader Goldstein, performed a true microscope-assisted spermatic vasectomy, which has been performed in more than a thousand cases. 2. Vasectomy: Microsurgical vasectomy is feasible for proximal obstruction after vasectomy, i.e., vas deferens-vasectomy. The vas deferens anastomosis. 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. In the case of bilateral vas deferens due to injury from hernia or testicular descending fixation surgery during childhood, assisted reproductive technology can be chosen, and vas deferens anastomosis can also be used for treatment. There are several methods of vasectomy to choose from, the simplest being the single-layer anastomosis technique or the modified single-layer anastomosis technique, which has the advantage of being simple to perform, requiring low microscopic skills and easy to promote, but with a lower success rate than the more advanced multi-layer anastomosis technique, of which the success rate of the Cornell Institute for Reproductive Research’s fine microdot multi-layer anastomosis technique can reach 99.5%. We currently use the multilayer technique.3, Vasectomy epididymal anastomosis: About 10% to 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. Another situation is that if no spermatozoa are found in the vas deferens fluid near the epididymis when a vasectomy is performed, but toothpaste-like mucus is found, it indicates that long-term ligation has led to secondary epididymal obstruction, and at this time it is also necessary to perform epididymal vasectomy instead of traditional vasectomy. 4. Ejaculatory duct obstruction: Azoospermia or severe oligospermia caused by obstruction at the ejaculatory duct can be treated by seminal vesicle In the case of azoospermia caused by non-obstructive azoospermia or severe oligospermia, azoospermia can be detected by microscopic exploration or transurethral ejaculatory ductotomy/ejaculatory duct cystectomy, which can lead to natural pregnancy in some patients’ spouses. 5. In the case of azoospermia, the small testicle can be cut open to search for spermatozoa, which allows for maximum protection of the testicular tissue and more precise detection of scattered spermatozoa. In technically mature centers, this exploratory procedure sperm discovery rate can reach 60%-70%, and then combined with assisted reproduction techniques, eventually enabling more people to obtain biological offspring.6. Erectile dysfunction: For infertility secondary to failure of intercourse due to erectile dysfunction, the first choice is first-line drug therapy, or second-line negative pressure suction, penile corpus cavernosum drug injection, etc. For patients with poor results or who cannot For patients who do not tolerate the results and are not willing to use assisted reproductive technology directly, vascular surgery of the penis or penile support implantation can be used depending on the cause. For sexual intercourse disorders due to penile curvature deformity, the 16-point technique can be used to correct penile curvature. As far as the current treatment for male infertility is concerned, medication, surgery and assisted reproductive technology each have their own most appropriate applications, but sometimes the choice varies depending on the doctor’s expertise and preference. For example, for the same patient with varicocele, some doctors may recommend surgery, others may recommend medication, while the doctor at the fertility center may directly recommend assisted reproduction. Who is right? Who is right? It may be a matter of analysis rather than generalization. We should not expand the indications for surgery because we are good at it, nor should we give patients medication because we don’t do surgery, nor should we expand the application of assisted reproduction technology indiscriminately. Of course, these techniques can sometimes be applied 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 reproduction techniques to finally allow the patient to obtain offspring is the most perfect combination of the three.