In our outpatient clinic, we male doctors often come across patients with azoospermia who are anxious and depressed, and often ask what to do if they have no sperm. Is it possible to get their own blood offspring? What is the cause? Can we check it out? Can it be treated with medication? Do I need surgery? What are the chances of finding sperm? Are the offspring healthy? What are the pitfalls and risks? ………. In the face of so many questions raised by patients, it is necessary for us to clarify the causes, classification, diagnosis and treatment of azoospermia in detail. In 1978, the world’s first in vitro fertilization (IVF) baby was born, and Robert Edwards, the father of IVF, was awarded the 2010 Nobel Prize for his work. Robert Edwards, the father of IVF, was awarded the Nobel Prize in 2010. After years of development, IVF technology has fulfilled the dreams of many infertile couples, however, among these infertile patients, there are some who cannot benefit from this cross-generation technology, which is the embarrassing situation faced by patients with non-obstructive azoospermia. 1999 years ago, when encountering this type of patients, doctors around the world were at their wits’ end and could only opt for sperm donation. 1999 years ago, the Cornell Medical Center in the United States began to develop a new technology to treat patients with azoospermia. Starting from 1999, Professor Schlegel of Cornell Medical Center in the United States reported microtesticular sperm retrieval, and found that through the effect of microscopic magnification, these patients still have localized spermatogenesis foci in the testes, that is, an oasis in the desert, and these “oases” contain a large number of sperms, which is enough for the woman to do IVF to have a child of her own. However, microscopic testicular sperm retrieval is still in the developmental stage in China, and only a few large hospitals in the provinces are able to carry out microscopic testicular sperm retrieval. Therefore, in China, doctors in most hospitals will suggest that such patients can only choose donor sperm. 1. What does azoospermia mean? Azoospermia means that no sperms are found in the ejaculated semen for 3 times in a row after centrifugal precipitation and microscopic examination. 2. What is the classification and occurrence of azoospermia? Azoospermia patients account for about 1% of the population of childbearing age and about 10%~15% of infertility, including obstructive azoospermia and non-obstructive azoospermia, of which non-obstructive azoospermia patients account for about 60% of azoospermia. 3.What are the causes of azoospermia? (1) Obstructive azoospermia:The testes have the function of spermatogenesis, due to the blockage of vas deferens and congenital absence of vas deferens. (2) Non-obstructive azoospermia: it can be divided into 3 categories: congenital (cryptorchidism, Kirschner’s syndrome and Y chromosome microdeletion, etc.), acquired (trauma, testicular torsion, varicocele, renal failure, inflammation, medication, high-temperature work, radiation and chemical damage, etc.) and idiopathic (unknown cause). 4. Can azoospermia be treated medically? At present, except for the azoospermia caused by hypogonadotropic hypogonadism, which can be treated by long-term hormone replacement therapy and theoretically can produce sperm, the rest of the azoospermia is very difficult to be treated by drugs. 5. What are the main treatments for azoospermia? (1) Obstructive azoospermia: (a) recanalization surgery (vasovaso-vas deferens anastomosis, vasovaso-epididymitis anastomosis, transurethral ejaculation orifice electrocautery); (b) ICSI through testicular puncture or biopsy sperm extraction. (2) Non-obstructive azoospermia (a) Sperm donor treatment (b) Testicular microsperm extraction + second generation IVF treatment 6. What are the surgical sperm extraction methods? There are many existing methods of sperm extraction, the more common ones are fine needle aspiration, open testicular biopsy and testicular micro sperm extraction. However, fine-needle aspiration and open testicular biopsy in testicular sperm retrieval have poor localization accuracy and are only suitable for obstructive azoospermia. For non-obstructive azoospermia, it is necessary to utilize testicular microsperm extraction. This technique was first reported by Schlegel in 1999, in which the operator opens the leukomastoid membrane along the equatorial surface of the testis and searches for full, opaque spermatogonial tubules under the 20-25x operating microscope, and then cuts down the tubules to look for suitable spermatozoa. 7.What is the theoretical basis of testicular microsperm extraction? In recent years, testicular pathology studies have shown that testicular spermatogenesis is focal and heterogeneous. Even if no spermatozoa are found in most of the seminiferous tubules of the testis, the presence of spermatozoa in a small portion of the seminiferous tubules cannot be excluded. 8.What are the conditions for practicing testicular microsperm extraction? (1) Strong laboratory and genetic laboratory diagnosis (complete and adequate assessment of testicular fertility and whether the spermatozoa retrieved will affect the next generation, etc.); (2) Good foundation in microsurgery; (3) Scarce single spermatozoa cryopreservation (the excess spermatozoa should be frozen as much as possible, so as to prevent the patient from unsuccessful once and then continue to perform ICSI with frozen spermatozoa); (4) Single spermatozoa intracytoplasmic sperm injection; (5) Support of sperm bank (sperm preservation); (6) Sperm bank (sperm storage). (5) Sperm bank support (bottom-up program, in case no sperm is found, sperm from the sperm bank can be used for treatment). 9. What are the advantages of testicular micro sperm extraction? (1) It can fully expose the testicular tissues without missing the “local spermatogenic foci”; (2) Under the magnification of microscope, it is more helpful for the doctor to stop the bleeding under the direct vision, and take more precise and smaller tissues, so that the damage can be reduced to a minimum. 10.What are the indications for testicular microsperm extraction? (1) Non-obstructive azoospermia patients who fail puncture biopsy; (2) Testes too small to be punctured; (3) Obstructive azoospermia patients who fail testicular puncture sperm retrieval on the day of egg retrieval; (4) Cryptorchid testis patients; (5) Patients with partial deletion of Y chromosome in the C region; (6) Kirschner’s sign (47,XXY); (7) Obstructive azoospermia patients with poor ovarian function of the female partner, avoid multiple puncture sperm retrieval. (8) Patients with obstructive azoospermia and poor ovarian function of the female partner, avoid multiple puncture sperm extraction. 11. Is the child born after the surgery the same as a normal child? According to domestic and international reports, if there is no obvious genetic disease in the preoperative examination of both male and female, there is no statistical difference between children born by this technique and other IVF. For cases where genetic diseases exist in both the male and female partners, it is often necessary to decide whether or not to proceed with the procedure after counseling by a geneticist and with the informed consent of both husband and wife. 12.Does the future sex life of testicular micro sperm extraction have any effect? The androgen level of these patients is generally low, and they need hormone therapy even without surgery; in addition, the literature and our own clinical practice have not found any obvious adverse effects, and foreign countries have reported that the androgen level of the patients can be restored to the preoperative level one year after the surgery. 13. What is the success rate of sperm retrieval and conception rate? At present, our hospital has carried out testicular microsperm extraction earlier in Hubei Province, and we have done nearly 400 cases from 2014 to 2019, with a sperm extraction success rate of 42.68% and a clinical pregnancy rate of 52.88%. 14. What is the operation procedure of testicular micro sperm extraction? (1) Both husband and wife complete all the examination results of the male partner in the male outpatient clinic with fully informed consent; (2) Generally hospitalized for 4-5 days, sperms are retrieved and handed over to the sperm bank for freezing and preservation, and if sperms are not retrieved, sperm supply may need to be considered for preparation in the future. Nowadays, testicular microsperm retrieval is much more sophisticated and requires much less sperm in terms of quantity and quality. Theoretically, only one morphologically normal, live sperm needs to be obtained, and combined with intracytoplasmic monosperm microinjection, fertilization and pregnancy may be possible, bringing hope for such patients to have offspring; if more sperm can be obtained during the procedure, sparse sperm can be cryopreserved for reuse in the next cycle after the first cycle of treatment fails; if no sperm is obtained during the procedure, or the sperm that is obtained does not meet the requirements of assisted If no sperm is retrieved during the procedure, or if the sperm retrieved does not meet the requirements for assisted reproductive treatment, sperm from a human sperm bank can be used as a “bottom-up program”.