If no sperm is detected in three semen tests in infertile men, azoospermia can be diagnosed. For patients with azoospermia, in addition to the need for palpation to examine the testes and epididymis and laboratory hormone tests, testicular biopsy is also a very important test. Under local anesthesia, a small piece of testicular tissue is taken through a puncture needle for pathological observation, which can directly determine the function of testicular sperm production or the degree of impairment in sperm production, and quantitatively evaluate the ability of testicular hormone synthesis and the degree of impairment, thus providing a reliable basis for the diagnosis and treatment of male infertility. If sperm can be found on biopsy and the spermatogenic cells are functioning normally, the female partner can enter the IVF process and the male partner can have a baby through assisted reproductive technology by testicular puncture for sperm extraction. If no sperm is found on biopsy, repeat puncture is also generally not recommended. Although the spermatogenic capacity of the testes is uneven and puncture will not cause too much damage, the chances of success are not significantly improved. If the patient has the desire to do it again, he or she can have another puncture examination one month after the first puncture. Patients who still cannot find sperm with repeat punctures can opt for micro-dissection testicular sperm extraction (MESE, micro-dissection testicular sperm extraction) in addition to sperm bank donor sperm to complete fertility. If the female partner is younger and the couple is still generous for fertility time, it is not impossible to restore sperm production through recuperation, elimination of unfavorable factors (such as occupational injuries, etc.) and the use of drug injection therapy. Some patients are very concerned about the checklist after the biopsy, especially about the column of “sperm vitality”. In fact, sperm need to be “energized” in the epididymis before they can have vitality, and most of them are inactive in the testicles. There is no need to dwell too much on this indicator. The testicular biopsy is an outpatient procedure that requires an appointment 2 to 3 weeks in advance at the time of consultation, and the cost of the entire diagnostic process, including pre- and post-testing and medication, is $1,600 to $1,700, less than $2,000. patients do not need to be abstinent before the biopsy, and sexual life and physical exertion will not affect the test results, but it is best to stop smoking and drinking. In case the patient is taking anticoagulant drugs such as clopidogrel and aspirin, he or she needs to stop taking them for a week before the biopsy. Most patients do not feel any discomfort after testicular biopsy, occasionally there will be some pain, which will disappear in a day or two; very few patients will have hematoma, some of them will get better after recuperation, some of them need surgery to stop the bleeding. Testicular biopsy does not destroy the testicular structure and has no effect on sexual function.