Sperm is a necessary weapon for men to show their virility, but if there is no sperm in the semen, it may make men feel “hopeless” at first sight. Fortunately, medical advances nowadays, even with azoospermia, sperm can still be successfully retrieved through testicular microscopy in a localized area of the testicle, and then through IVF technology, it is still possible to have a child and bring a ray of hope. Mr. Y, 33, and his wife had been married for 3 years and wanted to have a baby, but only after examination did they discover that they were azoospermic. Mr. Y suffered from mild cryptorchidism, and initial testicular sampling revealed that the spermatogenesis process was interrupted at an early stage of maturation and could not produce sperm. The doctor said that after medication and testicular microscopy, he confirmed that there was a localized area in the right testicle where sperm could be retrieved, and the sperm was successfully removed by microsurgery. What is azoospermia A normal male ejaculation is about 2 to 5 ml of semen, and semen is a grayish white to slightly yellowish, viscous liquid, which is made up of sperm and fluid. When the semen does not contain any sperm, it is called azoospermia. The first type of azoospermia can be classified as obstructive or non-obstructive: 1. The first type of obstructive type is when the testes can produce sperm normally, but cannot transport it to the semen. 2. The second type of non-obstructive azoospermia: It refers to the problem of the sperm-making process in the testes. Non-obstructive azoospermia means that the testes are not functioning well and cannot produce sperm or only very little sperm is produced. This is the most challenging part of male infertility because it is impossible to obtain sperm by normal testicular or epididymal sperm retrieval techniques, and more sophisticated testicular microscopy and microscopic sperm retrieval techniques are needed to obtain sperm for IVF artificial reproduction treatment. According to statistics, the fertilization rate of non-obstructive azoospermia patients who underwent IVF artificial reproduction with sperm obtained by testicular microscopic exploration and microscopic sperm retrieval was 77.52%, and the persistent pregnancy rate at more than 24 weeks was 36.8%, which was comparable to the 74.50% and 39.7% for obstructive azoospermia using testicular sperm retrieval and IVF. The pregnancy rate rose again to 41.2% for obstructive type and 50% for non-obstructive type. In other words, as long as sperm is available, the pregnancy rate, sustained pregnancy and live birth rate are almost the same for men with azoospermia due to either obstructive or non-obstructive causes. For non-obstructive azoospermia, there is a chance to obtain sperm for most of the azoospermia patients through microscopic testicular exploration for sperm retrieval, and with IVF technique, there is a chance to have a successful child. Diagnostic Microdissection Sperm Extraction Diagnostic Microdissection Sperm Extraction consists of the first part of microdissection-TESE and the second part of MicroTESE. In the first part of microdissection-TESE, the patient is placed under general anesthesia and the testes are sequentially divided through a median scrotal incision of approximately 4-5 cm. The testis is then incised in the median axis, and the intra-testicular vas deferens is examined under the guidance of a surgical microscope to locate the sperm ducts (sperm hiding in them) with a diameter greater than 300 μm. This not only shortens the time of the procedure, but also increases the chance of success. However, this method is rarely used today due to the secondary surgical injuries that can be caused to the patient, as sperm freezing and resuscitation techniques have become increasingly sophisticated.