Testicular biopsy, i.e. testicular biopsy, was once used as a traditional method to diagnose testicular lesions and determine spermatogenic capacity in the treatment of male infertility. However, since serum folliculopoietin (FSH) could be measured by radioimmunoassay, and especially since it was recognized that serum FSH levels could indirectly reflect the degree of testicular spermatogenesis in infertility patients, the scope of testicular biopsy was gradually reduced, and its indications were limited to azoospermic patients with normal testicular volume and normal or mildly elevated FSH levels. After the 1980s, the determination of seminal plasma biochemical (fructose, α-glucosidase, acid phosphatase, etc.) indicators for the exclusion of obstructive azoospermia, the scope of adaptation of testicular biopsy is even smaller. In recent years, semen cytology examination has been maturely promoted, and this examination determines the ability of sperm production by observing the abnormal morphology of spermatogenic cells in semen with abnormal proportions. For patients with azoospermia, if sperm cells are found in the semen, combined with other laboratory tests, it can basically be determined as non-obstructive azoospermia. One of the main purposes of testicular biopsy is to identify obstructive and non-obstructive azoospermia, which is also done by sperm cytology; in addition, testicular biopsy must be an invasive test and has certain complications. In view of the maturity of the above examination methods, testicular biopsy as a creative and invasive examination has been gradually replaced, so do not blindly perform testicular biopsy in clinical practice. In terms of spermatogenic function examination, histopathological sections of testicular biopsy are based on the degree of maturation of spermatogenic cells classified as normal spermatogenic function, hypospermatogenic function, spermatogenic block and only supporting cell syndrome. The diagnostic criteria of semen cytology smear: normal spermatogenesis when sperm cells are seen, spermatogenic stasis when there are spermatogenic cells (primary spermatocytes, secondary spermatocytes, spermatocytes) but no spermatozoa, no spermatogenic cells when no spermatogenic cells are seen, and only supportive cells without spermatogenic cells when supportive cells only syndrome is seen. Regardless of the type of testicular lesion or the degree of spermatogenic disorder, there is a disorder in the arrangement of spermatogenic cells and the shedding of spermatogenic cells, and studies have shown that all the tangible components that can be seen in semen are present in testicular biopsies with a 100% compliance rate. Therefore, it is possible to determine the spermatogenesis of the testis by the presence of shed spermatogonia or spermatogonia in the semen. Testicular biopsy has long been used mainly in patients with azoospermia to identify whether it is obstructive or non-obstructive, and germ cell cytology combined with seminal plasma biochemistry can do this very well. Glucosidase in seminal plasma biochemistry is secreted by the epididymis, fructose by the seminal vesicles, and acid phosphatase by the prostate. If the seminal plasma is negative for fructose, glucosidase <20 U/ml, and the seminal plasma PH is significantly decreased, and no spermatogenic cells are seen in the germ cell cytology, it can be determined as obstructive azoospermia. If the glucosidase is very low and the vas deferens is unsatisfactory on palpation, ultrasound examination of the seminal vesicles is feasible at this time. If the seminal vesicles are not found on ultrasound, congenital vas deferens, seminal vesicle agenesis or vas deferens hypoplasia can be determined. When the seminal plasma biochemistry is normal, PH 7.2~8.0, and spermatogenic cells have been found, then it can be judged as non-obstructive azoospermia; at this time, drugs to stimulate spermatogenic cells can be safely applied to promote the formation of spermatozoa, thus avoiding puncture biopsy of the already damaged testes and aggravating the damage. In the course of our treatment, we found that among the patients with azoospermia, there were already patients who underwent testicular biopsy outside the hospital, and then after our germ cell cytology and seminal plasma biochemical examination, the conclusions made by the patients were completely consistent with the pathological diagnosis of testicular biopsy. It can be seen that these patients could have avoided testicular biopsy if they had undergone the above mentioned tests first. There are other methods that can also help determine testicular pathology. It has been reported that in patients with azoospermia, if the testicular volume is less than 10 ml and the texture is soft, without other etiology, it can be considered as azoospermia due to testicular causes. Measurement of serum levels of testosterone (T), luteinizing hormone (LH) and follicle stimulating hormone (FSH) can clarify the site of hypogonadism, and to a certain extent, the serum concentration of FSH reflects the spermatogenic function. If there is also a testicular volume greater than 6 ml, reduced spermatozoa or severe sperm deficiency, and increased serum concentration of FSH, then primary spermatogenic impairment is indicated. If combined with low serum testosterone levels, appropriate supplementation of androgens can achieve good results at this time, which has been confirmed by years of clinical observation. In 1999, the American academic urology recommended that testicular biopsy should be contraindicated in cases of normal testicular size, testicular atrophy, Klinefelfer's sign, and androgen failure. In China, it has been concluded that patients with azoospermia or oligozoospermia with elevated serum FSH levels, decreased testosterone levels and normal seminal plasma biochemistry can be judged as primary spermatogenic disorders and testicular biopsy is unnecessary. In addition, with the continuous improvement of the level of reproductive medicine, especially the development of microsurgery and the application of microfertilization technology, ICSI has gradually matured, only one sperm can achieve conception, isolate a sperm from the semen or use spermatogenic drugs to get a sperm cell; that can provide sperm for ICSI, and scholars report that medical immunohistochemistry and in situ hybridization techniques to detect immature sperm in semen It is also reported that medical immunohistochemistry and in situ hybridization techniques to detect mutated cells in the germ cells in semen can diagnose testicular tumors, and if the isolated immature germ cells are used for the test, the detection rate can be improved, which shows that the scope of testicular biopsy is getting smaller and smaller, and more methods can replace this invasive test. Testicular biopsy methods have changed from incisional surgery to the current common use of coarse needle aspiration cytology, which can cause damage to the testis regardless of the form of biopsy. The limited number of puncture sites makes it impossible to make a comprehensive and accurate judgment of the spermatogenic function of the testis; after testicular puncture, the contact between sperm and blood and the contact between lymphocytes in the blood and the varicocele increases the chance of the occurrence of anti-sperm antibodies, which adds to the difficulties in the treatment of infertility. Furthermore, postoperative hematoma, pain, and risk of infection, and even serious psychological disorders, are problems that cannot be avoided with testicular biopsy. We have met a patient in the clinic, after testicular biopsy, inflammatory nodules occurred in the scrotum, both pain and discomfort and feel that the biopsy is not done, psychological pressure, reluctant to have sex with his wife, this tragedy can be avoided if testicular biopsy is carefully considered. Therefore, we advocate that testicular biopsy should not be carried out blindly, and that non-invasive examination should be considered first, which is also advocated by evidence-based medicine, so that there is no need to increase the patient's pain after the corresponding determination can be made.