The grass is green again in spring, the Qingming Festival, tomb sweeping and ancestor worship, trekking and playing. However, some men are depressed and worried about having no sperm to pay respect to their ancestors. During outpatient visits, I encounter inquiries from this group of patients: Hello doctor, how can I have no sperm and what is all the fluid I ejaculate? I will patiently explain the difference between azoospermia and azoospermia. Generally, the fluid emitted during sex or masturbation is called semen, and semen contains sperm. For example, we commonly have rice porridge, semen is like rice porridge, sperm is like rice grains, azoospermia is like rice soup – rice porridge without rice grains. It does not necessarily interfere with sexual life and the existence of the disease may be completely unknown until one does not expect to have children. Although it can cause a lot of psychological stress, a large percentage of azoospermia patients are actually able to conceive their own babies through treatment. Azoospermia accounts for 1 to 2 percent of all men and 10 to 15 percent of male infertility cases. Azoospermia is defined as the absence of sperm found in two semen samples of 3000 G, microscopic examination after 15 minutes of centrifugation. Generally azoospermia is divided into two conditions: obstructive and non-obstructive, the former like a blocked transport channel and the latter like a manufacturing plant stoppage. Most patients with obstructive azoospermia have a combination of low ejaculate volume, normal testicular size, normal sex hormones, and when the semen pH is less than 7.2, transrectal ultrasound (TRUS) can be applied to examine the seminal vesicles or ejaculatory ducts. For obstructive azoospermia, obstruction of the epididymis, vas deferens, and ejaculatory ducts, natural conception can be achieved by recanalizing the reproductive ducts through different surgical procedures, such as microscopic epididymal vas deferens anastomosis, vas deferens vas deferens anastomosis, and seminoscopic ejaculatory duct cystopexy. However, for patients with multiple stenosis of the reproductive ducts caused by reproductive system infections and congenital vas deficiency, recanalization of the reproductive ducts cannot be achieved, and the only way to have offspring of paternal lineage is through percutaneous epididymal puncture combined with second-generation IVF. Non-obstructive azoospermia accounts for 60% of patients with azoospermia, and the most common cause is primary testicular dysfunction due to severe defects in sperm occurring. Most patients have normal semen volume, elevated sex hormone FSH, and testicular atrophy, etc. Examination for chromosomal and Y chromosome AZF microdeletions is recommended. Drugs are mainly treated by endogenous testosterone, including the following three kinds: first, letrozole; second, human chorionic gonadotropin (hCG) + urinary gonadotropin (HMG); third, clomiphene. The procedure consists of two main types: percutaneous testicular aspiration and microscopic orchidotomy for sperm extraction. 2018 American Reproductive Medicine Expert Consensus Microscopic orchidotomy for sperm extraction has a sperm acquisition rate of 52%, which is 1.5 times higher than the former. Its advantages as a delicate operation include two main points: first, the testis is cut 3/4 of the way along the equator to fully expose and not miss any of the focal spermatogenic tubules; second, the magnification of 15-20 times through the operating microscope helps to find the full, opaque “local spermatogenic foci” during the procedure, like finding an oasis in the desert. The search for sperm like a needle in a haystack increases the probability of finding sperm in patients with non-obstructive azoospermia and the chances of having offspring related to the father’s blood. Between 60% and 70% of patients with azoospermia can obtain sperm through medication or surgery and have their own children. Only a few patients such as men with Y chromosome AZFa and b deletions consider donor insemination and cuddling.