Our male doctors often encounter patients with obstructive azoospermia who need to undergo testicular puncture for sperm extraction. Does it hurt to have a testicular puncture for sperm extraction? What do we need to pay attention to? In the face of so many questions from patients, it is necessary for us to make a detailed clarification of some considerations for testicular puncture for sperm extraction in obstructive azoospermia. 1.What is azoospermia? Azoospermia means that the ejaculated semen is not found by microscopic examination after centrifugation and sedimentation for 3 consecutive times. 2. What is the classification and occurrence of azoospermia? Patients with azoospermia account for about 1% of the population of reproductive age and about 10% to 15% of infertility, including obstructive azoospermia and non-obstructive azoospermia, with patients with non-obstructive azoospermia accounting for about 60% of azoospermia. 3.What are the causes of azoospermia? (1) Obstructive azoospermia: the testes have spermatogenic function due to blockage of the vas deferens and congenital vas deficiency, etc. (2) Non-obstructive azoospermia: It can be divided into 3 categories: congenital (cryptorchidism, Creutzfeldt-Jakob syndrome and Y chromosome microdeletion, etc.), acquired (trauma, testicular torsion, varicocele, renal failure, inflammation, drugs, high-temperature work, radiation and chemical injury, etc.) and idiopathic (unknown cause). 4.The main treatment modalities of azoospermia? (1) Obstructive azoospermia: (a) recanalization surgery (vas deferens-vas deferens anastomosis, vas deferens-epidididymal anastomosis, transurethral ejaculation electrosurgery); (b) ICSI treatment by testicular puncture or biopsy for sperm extraction. (2) Non-obstructive azoospermia (a) Sperm donor treatment (b) Testicular microsperm extraction + second generation IVF treatment 5. What is testicular puncture for sperm extraction? Testicular puncture is a kind of testicular biopsy, mainly for patients with obstructive azoospermia. It is both a diagnostic and therapeutic clinical technique, which mainly involves surgically removing a small piece of testicular biopsy to understand the spermatogenesis of the testes according to the testicular tissue structure and germ cells. 6.What groups of people need testicular puncture for sperm extraction? At present, the examination methods to assess the spermatogenic function of the testis include routine semen examination, sex hormone and inhibin B examination, seminal plasma biochemical examination and scrotal ultrasonography, etc. However, if no spermatozoa are seen in the semen examination, these examination methods cannot directly reflect the spermatogenic function of the testis compared with testicular biopsy. This is because testicular biopsy is a direct examination of the varicocele of the testis, while endocrine and biochemical examinations are an indirect way to understand the spermatogenic function of the testis. At present, testicular biopsy is still the gold standard for diagnosing testicular spermatogenesis, so for patients with azoospermia, testicular puncture can be performed if the cause is unknown and the testicular volume is still acceptable (usually at least greater than 6 ML). If the puncture has sperm, then one can try second generation IVF (ICSI) to have their own child. In some patients, even if obstructive azoospermia is highly suspected, such as a previous history of fertility and later azoospermia due to a history of epididymitis or vasectomy, an early puncture is performed to understand testicular spermatogenesis before vas deferens or vas deferens-epidididymal microanastomosis. But even if there is no sperm in the testicular puncture, it cannot be said that there is no hope. Nowadays, a small amount of sperm can be found to help fertility through testicular microsperm extraction. 7. How to do testicular puncture for sperm retrieval? After surface anesthesia + spermatic cord block anesthesia, a special puncture needle or a 20ml syringe needle and needle can be used to puncture the testicles under a sterile environment and extract a small amount of testicular tissue, which can then be placed under a microscope to observe the presence or absence of sperm or perform HE staining for testicular exfoliation cytology to determine the spermatogenic function in the testicles. 8.Does testicular puncture have any effect on the body? In fact, under normal circumstances, there are about 300 to 1,000 seminiferous tubules in a man’s testicles, and these tubules are mainly connected to the testicular output tubules by dozens of small tubes. If only a small amount of testicular tissue is extracted, the structure and output ducts of the testicular seminiferous tubules will not be affected. However, it is important to note that the balls are after all a fragile aristocracy, without muscles or bones, and prone to egg pain. In addition, because the testicular puncture process is blind, very few people may have testicular hematoma due to touching the blood vessels in the testicle, so it is necessary to press the testicle on the punctured side for at least 10 minutes after the operation. After the operation, pay attention to the wound dryness and take oral antibiotic treatment. If a mild hematoma occurs, reduce activities and rest quietly. Generally, in about half a month, the hematoma will be gradually absorbed and the pain will be gradually relieved; however, if the hematoma gradually increases, it is recommended to seek emergency medical attention and if necessary, testicular incision is needed to stop the bleeding. Generally, as long as you pay attention to pressure rest after the operation and follow the doctor’s words, the probability of the above situation is smaller. 9.What preparations are needed before the puncture? Although the testicular puncture is not a major operation, it is an invasive operation, and the location is so critical for the majority of gay men, so some preparations should be made before the operation to reduce the risk of damage to the balls. First of all, some blood biochemical tests need to be completed to understand whether the patient has inflammation, coagulation abnormalities or infectious diseases, so as to avoid coagulation abnormalities leading to hematomas and so on. At the same time, it is generally necessary to prepare the skin before surgery, that is, to shave the pubic hair of the perineum, so as to facilitate the operation of the doctor on the one hand, and reduce the risk of wound infection on the other.