Since our center improved the surgical method of microscopic sperm retrieval in 2014, the success rate of testicular sperm retrieval for azoospermia has been stabilized at around 50%, and we have retrieved sperm for many patients with testicular sperm failure and successfully assisted them in “in vitro” fertilization. Since this technology was introduced to Guangdong relatively late, many patients, medical staff, and even doctors engaged in male and reproductive specialties do not know about it, therefore, we will answer some of the questions frequently asked by outpatients. 1. We can find sperm for some patients with difficulties Patients with significantly reduced testicular volume (testicular volume of 2 ml, about the size of a peanut) Significantly elevated FSH in the blood test (the highest FSH in a successful sperm retrieval case was 74 IU/L) No sperm was found in previous testicular biopsies performed at outside hospitals (microsurgery improves sperm retrieval rate by about 20%) An extra chromosome, 47 XXY, is present (the success rate of microsurgical sperm retrieval will not be reduced) Waiting for sperm donation Patients with artificial insemination or “in vitro” (will not delay the waiting time for sperm supply) Testicular atrophy and azoospermia after mumps Testicular atrophy and azoospermia after chemotherapy Testicular atrophy and azoospermia after cryptorchid testicular surgery in early childhood or adulthood, with no sperm detected Q: I have had a testicular biopsy done in an outside hospital and no sperm was found, is microsurgery necessary? Q: I have already had a testicular biopsy in an outside hospital and no sperm was found. A: For patients with serious spermatogenic disorder of testis, microsurgery is more targeted than traditional incisional biopsy or puncture biopsy, and it is easy to find a small amount of spermatogenic tissues locally, and domestic and foreign statistics show that microsurgery can improve the success rate of sperm retrieval by about 20%. Q: I have already seen many hospitals that say the testicles are too small and the blood test indicators are too high to find sperm A: Due to the limitation of technical means, the traditional viewpoint is not to recommend sperm retrieval surgery for those patients with severe testicular dysplasia and significantly elevated FSH because the success rate is too low; however, the development of microsurgery has broken through this barrier. The prestigious Cornell University in the U.S. summarized the results of their 1,127 cases of microsperm retrieval in 2014, and found that even with testicular volume as small as 2 ml (the size of a peanut), more than half of the patients were still able to retrieve the sperm; and abnormalities in blood FSH and inhibin B tests did not reduce the success rate of microsperm retrieval. From the results of the surgery in our center, the conclusion is consistent with them, and several patients with small testicular volume and blood FSH 30 or more have already found sperm. Q: We have already done donor insemination, will the sperm retrieval procedure delay me from queuing up for donor “in vitro”? A: As long as the patient has the desire to have his/her own offspring, he/she can make an appointment for sperm retrieval at our center and apply for donor sperm at the same time as registering for sperm retrieval. Currently, the waiting time for sperm donation is 3-6 months. Patients can make use of the waiting period for sperm donation to arrange for the surgery, and if sperm is found, the sperm donation can be canceled directly and the fee can be refunded; if sperm is not found, the patient will continue to wait for sperm donation and the waiting time will not be prolonged. Q: Is anesthesia required for microsperm retrieval, and what is the cost of the procedure, length of hospital stay, and success rate? A: Micro sperm retrieval is routinely performed under local anesthesia, with low cost and quick recovery. The first day of hospitalization is arranged for examination, the second day of surgery, and the third day of discharge from the hospital, and the patient is allowed to eat and get out of bed before and after the surgery, with a hospitalization cost of about RMB 3,500-4,000. If sperms are found successfully, the additional fee for freezing and preserving sperms will be RMB 2,000. Currently, the success rate of surgical sperm retrieval is about 50%, which is related to the causes and conditions of different patients, and will be explained in detail by the outpatient doctor according to the patient’s situation. Q: Can the sperm found in the surgery be preserved, and if the first “test tube” is unsuccessful, what should I do in the future? A: Microsurgery is mainly for patients with very poor testicular function, and the sperm obtained is even more precious. We will try our best to divide the sperm into 2-3 parts for freezing and preservation, so that even if the first “test tube” is unsuccessful, there is still a chance to continue to assist in the fertilization process in the future. If the sperm is too small to be divided, we will give specific instructions to the patient. Sperm can be kept for half a year (enough for 2 IVF treatments), please apply for extension of the preservation period due to special circumstances, and according to the relevant national regulations, the sperm taken out by surgery cannot be transferred to other hospitals. Q: If I am born with an extra chromosome, 47 XXY, is it true that there is no hope of finding sperm and that even if I have children, they will not be normal? A: Even if the chromosome is 47 XXY, there is still a chance of finding sperm, and the probability of finding sperm is higher than that of azoospermia of unknown cause; such patients often have poor testicular development and abnormal blood hormone levels, but the probability of finding sperm will not be lower because of this. According to the statistics of microscopic sperm retrieval cases worldwide, the success rate of sperm retrieval in 47 XXY patients is more than half; the probability of chromosomal abnormality in the offspring born is less than 1%, and the safety of IVF is the same as that of other azoospermic patients. Q: How to arrange for surgical sperm retrieval if I have no sperm after chemotherapy? A: First of all, it is recommended to go to a sperm bank to freeze sperm before chemotherapy; if no sperm is found after chemotherapy, it is routinely recommended to stop using chemotherapy drugs and other drugs that may interfere with spermatogenesis for half a year before surgical sperm retrieval. Q: Is it possible to retrieve sperm surgically in cryptorchidism where one testicle has been removed, or the testicle is hidden in the abdominal cavity, or the testicle cannot be felt in the scrotum? A: First of all, it is recommended that children receive cryptorchid surgery before the age of 2 to pull the testicle from the abdominal cavity to the scrotum; if the surgery is not performed in time at an early age, it should also be performed as soon as possible in adulthood. For patients who have undergone testicular descent surgery and still have no sperms after the surgery, sperm retrieval surgery can be arranged, and the probability of finding sperms in such patients is more than 60%; for patients who have not undergone testicular descent surgery, the testicles should be pulled into the scrotum as soon as possible by surgery, and the semen will be rechecked for sperms 3-6 months after the surgery, and if no sperms have been found after 6 months, the sperms can be found by microscopic surgery.