Wang is a young and talented IT elite (30 years old), married and living together for 3 years, his spouse is a virtuous and beautiful white-collar foreign enterprise (26 years old), has used condoms for contraception for 1 year, the last 2 years of stable work, family income is rich, consider adding a new member to the family. Both parties had made sufficient preparations (quit smoking and drinking, exercise, sleep early and wake up early, strengthen nutrition, balance diet, supplement micronutrients and vitamins, etc.) and expected to welcome the arrival of their love child, but the wife’s belly was slow to move. She came to our department for help under the pressure of both parents. He was diagnosed with oligospermia, weakness and malformation at the local hospital. He was given conventional medication for 3 months (one course of treatment), but there was no significant improvement in the semen on recheck. After the consultation, it was learned that both Wang and his spouse underwent free marriage examination when they got married, and the results were completely normal, while Wang’s spouse had regular menstrual cycle, normal gynecological routine ultrasound, normal white belt routine, and normal sex hormone examination on both sides. During the physical examination, he found that the left spermatic cord was thickened in clumps and became more obvious when he held his breath, so he was considered to have left spermatic varicose vein, so he was recommended to have scrotal ultrasound examination and semen recheck as a reference for treatment effect. 20.3%. morphology: N 2%. Based on the preliminary examination results, I gave a diagnosis (1 male infertility; 2 oligospermia, weak and malformed sperm; 3 left spermatozoa varicose veins) and suggested to choose assisted reproductive technology to help the female partner conceive while continuing to take medication, and the male partner needs to be tested for karyotype and y chromosome microdeletion in peripheral blood cells first. When Mr. and Mrs. Wang learned about the cost of expensive tests, the long waiting time and the extremely low success rate (the clinical pregnancy rate per cycle is 10-15% for IUI and about 45% for IVF), they refused the tests and requested other treatments. In response to the dilemma faced by Xiao Wang and his wife, I proposed what I thought was the most appropriate treatment plan: a “ligation” of the varicose spermatic vein. The couple was shocked to hear that “ligation” is sterilization and can cure male infertility? It’s a good idea to get a good idea of what to expect. Facing the panic faces and suspicious eyes of two people, I explained to them with a smile: 1 this “ligation” is not the imaginary vasectomy ligation, but simply ligation of the veins with dilated lumen caused by venous blood reflux, eliminating the toxic metabolites and high temperature generated by blood stagnation brought by venous blood reflux, and not reducing the dilated veins. 2 Generally, surgery is not needed if the varicocele is not combined with poor semen parameters and pain and atrophy of the affected testicle; 3 For patients with varicocele with abnormal semen parameters, the initial treatment can be either conservative medication or surgery (if the female partner is of age or has her own disease, assisted reproduction techniques such as intrauterine insemination or in vitro fertilization are recommended), but if the treatment has already been performed However, if a course (3 months) of conventional medication is ineffective, surgery is highly recommended.4 At present, varicocele surgery is very mature (including traditional, laparoscopic, microscopic and other methods), especially the microscopic episcleral spermatic vein ligation under local anesthesia carried out by our department can not only protect the testicular arteries and lymphatic vessels, but also completely ligate the varicose veins to prevent postoperative recurrence due to omission, while Local anesthesia greatly reduces the cost and risk of surgery and eliminates the need for hospitalization.5 The efficiency of surgical treatment is about 70% (improvement in as early as 1 month and as slow as 3 months), and even if the surgery alone does not improve semen quality significantly, post-operative medication and assisted reproduction can achieve better results. After hearing my detailed analysis, the couple finally decided to improve the semen quality by micro-ligation of the spermatic vein first, hoping that the woman could conceive naturally after the surgery. More than 1 month after the surgery, the semen parameters were completely normal after 4 days of abstinence. 4 months later, he sent me a text message happily telling me that his wife was 6 weeks old and the fetal heartbeat was normal on ultrasound.