Some patients are diagnosed with “dead sperm” when they find no motile sperm in their semen during semen examination. Are these non-motile sperm really dead? This is the first question that the doctor has to determine, either by eosin, aniline blue staining or hypotonic swelling test to determine if the non-motile sperm are dead. There is a congenital disorder called cilia immobility syndrome, where the patient’s sperm cannot move due to cilia dysfunction, but the sperm are alive, just not moving. If all the sperm are colored by eosin staining, it proves that these sperm are dead and the cell membrane has lost its rejection of the dye, and such dead sperm cannot be used for IVF. In general, there are differences in the manifestations of dead sperm due to different etiologies: 1) spermatozoa have died in the seminiferous tubules; 2) spermatozoa die in the epididymis due to lack of epididymal function after generation; 3) dead spermatozoa at different developmental stages of cell morphological characteristics, mostly with different disease histories or medication histories. Patients with dead sperm often need to be examined for reproductive tract infections, reproductive endocrinology, and attention to screening for genetic abnormalities, such as karyotype and Y chromosome microdeletions. So is it true that a patient with dead sperm has no chance to become a father? If no clear cause can be found and no live sperm can be found in the semen after treatment, sperm extraction through testicular or epididymal puncture can be considered. In most cases, the spermatozoa are still alive at the beginning of sperm production and their genetic material is not damaged. In vitro fertilization with single sperm injection using motile sperm obtained by intra-testicular puncture has been reported for the treatment of dead spermatozoa and successful delivery of healthy offspring.