1. 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, which was first reported by Schlegel in 1999. The operator opens the leucoderm along the equatorial surface of the testis and searches for full, opaque spermatogonial tubules under a 20-25x operating microscope, and then cuts them down to find suitable spermatozoa. 2.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 part of the seminiferous tubules cannot be ruled out. 3.What are the conditions for practicing testicular microsperm extraction? (1) Strong laboratory and genetic laboratory diagnosis (complete and adequate assessment of testicular fertility and the impact of sperm retrieval on the next generation, etc.); (2) Good foundation of microsurgery; (3) Scarce single sperm cryopreservation (excess sperm should be frozen as much as possible, so as to prevent the patient from unsuccessful once and then continue ICSI treatment by using frozen sperm again); (4) Single sperm follicular plasmapheresis injection; (5) Support of sperm bank (sperm preservation); (6) Sperm bank (sperm bank); and (7) Sperm bank (sperm bank). (5) Sperm bank support (bottom-up program, in case no sperm is found, sperm from the sperm bank can be used for treatment). 4. 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 accurate and smaller tissues, so that the damage can be reduced to the minimum. 5.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 puncture sperm retrieval on the day of egg retrieval; (4) Cryptorchidism 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, to avoid multiple puncture sperm retrieval. (8) Patients with obstructive azoospermia and poor ovarian function of the female partner.