Many people are frustrated and burdened by the diagnosis of azoospermia. Strict diagnostic criteria and individualized treatment plans are essential in the field of assisted reproduction, so let’s learn how to create sperm from nothing in different cases. First of all, we need to clarify whether it is “non-obstructive” azoospermia due to testicular spermatogenesis failure or “obstructive” azoospermia due to intact testicular spermatogenesis but incompetent vas deferens, because the treatment options for these two causes of azoospermia are completely different. The treatment options for these two causes of azoospermia are completely different. The common causes of obstructive azoospermia are: intra-testicular obstruction, obstruction caused by inflammation of the epididymis, obstruction of the ejaculatory duct, congenital bilateral vas deferens, etc. The testicular volume and blood hormone level of these patients are often normal, and we can further clarify the diagnosis through physical examination and ultrasound. The first trick of “making something out of nothing”: patients with obstructive azoospermia can remove sperm through testicular or epididymal puncture and get a real child of their own through “IVF” technology; or they can realize the recanalization of the vas deferens through surgery, so that sperm can be normally discharged from the body, thus successfully having children. The procedure can be done to recanalize the vas deferens, so that the sperm can be excreted normally and the child can be born. Treatment of non-obstructive azoospermia is much more difficult and less successful than obstructive azoospermia. The common clinical causes of non-obstructive azoospermia include genetic abnormalities (Y chromosome microdeletion, Crohn’s syndrome), endocrine abnormalities (Kalman syndrome, IHH), orchitis, varicocele and cryptorchidism. Such patients often have smaller testicular volume, abnormal blood hormone levels, and cannot produce or can only produce a very small amount of sperm in the testes, resulting in sperm not being found in the semen. So, what can be done in this case? The second method of “creating sperm from nothing” is the “three-step sperm retrieval” method, in which patients with non-obstructive azoospermia undergo testicular fine needle aspiration, testicular biopsy, and testicular microscopic sperm retrieval in sequence, and each time the testicular tissue is obtained, the sperm is searched for under an inverted microscope, and if sperm is found in a particular step, the procedure is terminated. If sperm are found in a particular step, the procedure is terminated, and if not, the procedure is performed sequentially, and finally ICSI is used for assisted reproduction. The third method of “creating something out of nothing”: Patients with azoospermia due to low levels of GnRH and/or LH and FSH production and secretion can be treated with sequential injections of FSH combined with hCG, or hormone pump injections that mimic pituitary pulsatile hormone release, which can effectively promote spermatogenesis and thus achieve the goal of “creating something out of nothing”. “creating a baby out of nothing” and having a baby of their own. Only after all attempts have failed do we go on to consider donor sperm IVF. Let’s not give up lightly in the pursuit of having our own baby!