It is not uncommon to find spermatozoa in male clinics, but routine semen tests do not find sperm yet anxiously sentenced to “death”, let’s slowly analyze. The azoospermia confirmation: 1, generally need two semen tests without sperm to confirm, and semen should be centrifuged microscopic examination, can not simply draw a conclusion. Some patients may find 1 or 2 sperm after centrifugation, at which point our clinical treatment plan is completely different. 2, the integrity of the semen specimen: there are patients who are azoospermic in the initial examination, and careful questioning reveals that the patient has difficulty taking sperm in the hospital environment and only ejaculates a few drops of prostate fluid, so he is azoospermic. The laboratory test again was completely normal. 3, physical examination and sex hormone examination: experienced doctors have basically determined the diagnosis by feeling the testicles. There are two types of azoospermia, one is obstructive azoospermia and the other is non-obstructive azoospermia. The former is caused by obstruction of the reproductive ducts. Obstruction of any part of the epididymis, vas deferens, ejaculatory ducts, or prostate gland may result in failure to discharge sperm, and common causes include bilateral vas deferens, epididymitis, and ejaculatory duct cysts. The latter is due to dysfunction of sperm production in the testes themselves, which is when the factory stops producing. Azoospermia due to obstruction can be surgically unblocked, such as ejaculatory duct cysts, post-vasectomy, caudal epididymal obstruction, or IVF can be used, with a pregnancy rate of 80% per egg retrieval cycle if the female partner has no specific abnormalities. Patients with spermatogenic dysfunction may have desert oases producing small amounts of sperm, and a few sperm found by testicular puncture can also be used for IVF, bringing a ray of hope for fertility. Thanks to advances in microsurgical techniques, it is possible to obtain sperm for IVF treatment by micro-testicular sperm extraction (micro-TESE), even if the testes are poorly developed. Some non-obstructive azoospermia is medically treatable, such as kallmann syndrome, idiopathic hypogonadotropic gonadal dysplasia, and definite endocrine abnormalities, for which a clear diagnosis is important. More non-obstructive azoospermia hoping for medication to appear sperm and conceive naturally is mostly futile, but medication can be used as an adjunct to improve the chances of sperm acquisition prior to another surgical sperm retrieval. Is there any hope for IVF with Y chromosome microdeletion? Azoospermia factor (AZF) deletion on the Y chromosome can cause severe spermatogenic dysfunction. This test is required for both non-obstructive azoospermia and severe oligospermia. From the current literature, with complete deletion of AZF zones a and b, the patient will basically not find sperm in the testis, and partial deletion of zone b is still promising. patients with AZF zone c deletion may present with severe oligospermia or azoospermia, and azoospermic patients may attempt testicular sperm retrieval. If sperm is found in the testes for IVF, the success rate is less than that of obstructive azoospermia, but at least it brings the hope of having offspring. When a Y chromosome microdeletion is found, it is not recommended to delay further attempts at medication, but to use IVF decisively. This disease can be passed on to the next generation of boys, so please seek genetic counseling prior to IVF treatment. Azoospermia patients need to learn to give up! In non-obstructive azoospermia, if sperm cannot be obtained in the testes, or if the chances of finding sperm in the testes are low after a comprehensive evaluation, it is not a bad idea to give up treatment. If you know that there is no hope and you try various “prescriptions” for a long time, it often costs you money or hurts your liver and kidney function, and you end up with no success.