Azoospermia is defined as the presence of semen ejaculation during sexual intercourse, but no sperm are found in the semen. Azoospermia is not rare and accounts for about 1 to 2 percent of the entire population, which means that about one in 50 to 100 men may have azoospermia. At least 30 million men worldwide have been diagnosed as azoospermic. The serious reality of infertility makes patients suffer from pain and seriously affects their family harmony and quality of life, and even broken love. How can we turn azoospermia into sperm production? It is the dream of male physicians all over the world to realize the birth of something from nothing. Azoospermia is divided into 3 types 1, the most common is testicular azoospermia, due to testicular disease itself, resulting in the failure of spermatogenic tubules in the testes, unable to produce sperm; 2, followed by congenital abnormalities or obstruction of the testicular sperm output pipeline, resulting in sperm discharge disorders, which is a disease of the spermatogenic pipeline; 3, less common is the third type, due to hypothalamic pituitary gland disease resulting in abnormal reproductive hormone invention which affects the function of the testicular spermatogenic tubules. For the latter two problems resulting in azoospermia, our male physicians can completely create something out of nothing. The testes and epididymis Three moves to deal with azoospermia The first move: sex hormone injection When a patient with azoospermia, testing sex hormones found that gonadotropin (FSH, LH) and testosterone (T) levels are relatively low, the so-called hormone three low, or accompanied by reduced nose smell, this is considered azoospermia caused by hypothalamic secretion hormone disorder, the treatment of this azoospermia is drug therapy, can After treatment, sperm will appear, the amount of semen will gradually increase, and beard, throat knot, and armpit hair will gradually appear. Immediately after the appearance of sperm, sperm freezing is started or fertility is prepared. The second trick to create a sperm from nothing: microscopic and minimally invasive surgery to recanalize the vas deferens If the testicles are found to be normal in size and the five sex hormone tests are normal when an examination is given for azoospermia, the vas deferens obstruction is considered to be the cause at this time. The obstruction can be in the testicular network, epididymis, vas deferens, or the ejaculatory duct with the posterior or anterior urethra. For this obstructive azoospermia, our physicians can moreover create something out of nothing. The male sperm transport pipeline can be reconstructed through non-invasive or minimally invasive surgery. (1) If physical examination reveals normal testicles/epididymis enlargement, normal semen volume and normal hormones, and ultrasound confirms obstruction, consider it to be epididymal obstruction, microsurgical vas deferens-epididymal connection surgery can be chosen. Currently, we can achieve a connection rate of 60% to 80%, and the natural pregnancy rate after surgery can reach 30% to 40%, and the cost is one-third of IVF. Sperm and egg (2) If you have had a vasectomy or hernia surgery in the past and are considered to have vasectomy obstruction, the vasectomy recanalization rate can now reach 90~99%. If high vas deferens obstruction, laparoscopic assisted recanalization surgery is needed, which is better, with small incision, less trauma and easy to find the two broken ends of the vas deferens. (3) If the ejaculate volume is very small and thin, it may be an obstruction of the ejaculatory duct or congenital lack of development of the seminal vesicle gland. Transurethral ejaculatory ductotomy is the first consideration. Of course part of the obstructed azoospermia is due to the absence of both vas deferens and seminal vesicles, and then IVF is considered after testicular or epididymal sperm extraction. The third trick to create sperm from nothing: microscopic sperm retrieval and stem cell manufacturing When testicular vas deferens factors are ruled out and hypothalamic pituitary disorders are also ruled out, these patients are testicular azoospermia. (1) For this group of patients, we should not rush to surgery and give patients more chances to recover. Recent studies have found that certain drugs such as letrozole, carnitine, PDE5 inhibitors, and Chinese medicine discriminatory treatment are of some value, and repeated semen centrifugal testing sometimes reveals active sperm. The fertility center should carry out sperm freezing and thawing as soon as possible, and freezing and thawing is also an option for inactive live sperm. (2) When treatment is carried out for six months and repeated semen analysis and centrifugal testing is still without sperm for six to eight times, surgical sperm retrieval can be considered. Finally, a three-step sperm retrieval procedure is adopted: ① testicular puncture technique is performed first; ② if there is no sperm choose the testicular 5-point biopsy technique; ③ if still no sperm is found, consider microscopic sperm retrieval technique, which can be chosen 1~2 days before the day of egg retrieval, or establish a new technique of sparse or single sperm cryopreservation. (3) When no sperm is found in the operating room, testicular tissue should not be discarded and continue to be carefully cultured. Sperm can be found in about 5-10% of patients by culture or multiple observations. Once found, freeze and preserve immediately. (4) Of course, now that our medical science is advancing, making sperm cells from stem cells is no longer a myth and legend. We have chosen seed cells such as spermatogonial stem cells in the testis, induced pluripotent stem cells made from the skin, embryonic stem cells, etc. Nowadays, medical science is advancing and we have done this experiment in animals, but the experiment in humans is still in its initial stage, and the safety and effectiveness of obtaining sperm is a challenge for us because we have to use certain transgenic techniques. Moreover, the research funding for each experiment is relatively expensive, and our research team is struggling day and night, night and day.