Patients with azoospermia who do not find sperm on testicular biopsy are not alone in having donor sperm. If they still wish to have children with their own sperm, they can also find sperm through microscopic sperm retrieval – the doctor cuts open the testicle, looks for sperm under direct microscopic view and aspirates it, in conjunction with intracytoplasmic single sperm injection by the woman (i.e. “second-generation IVF”) for fertility. In the case of azoospermia due to “small testes”, testicular puncture is more difficult and the probability of obtaining sperm is lower. However, for azoospermic patients with normal sized testes, if no sperm is found by puncture, microsperm retrieval is generally not recommended and their probability of finding sperm is limited, especially if the amount of testicular tissue obtained during puncture is very large. Of course, patients who are keen to have children with their own sperm can try microsperm retrieval after puncture. A comprehensive assessment of the patient’s condition by testicular size and hormone levels is required before microsperm extraction surgery. If the success rate is low, for example, hormone levels such as FSH are not normal, oral or injectable medications such as HCG, HMG, or direct FSH supplementation, etc., can be used to assist in boosting sperm volume. The length of medication is determined by the size of the patient’s testicles, the age of the wife, the length of treatment acceptable to both spouses, etc. Generally speaking, surgery can be performed after six months to one year of treatment. Generally, the testicular microsperm extraction procedure involves a 1-2 day hospital stay, with little discomfort, no interruption of sexual life, and no visible scarring. Microsperm extraction is the treatment with the highest chance of obtaining sperm. If sperm extraction fails, the surgeon will assess the patient’s suitability to do it again based on intraoperative conditions (such as the development of spermatogenic tubules in the testes). In between, patients are advised to make self-adjustments, such as quitting smoking and drinking, avoiding overexertion, avoiding occupational disadvantages (e.g. exposure to paint, radiation, etc.), and may be assisted with appropriate medication. However, if repeated sperm retrieval fails, IVF can only be performed through donor sperm.