Studies have shown that testicular spermatogenesis in patients with non-obstructive azoospermia is heterogeneous and focal. Examination of these focal spermatogenesis specimens revealed that the diameter of the tubules with spermatogenesis was larger than that of tubules with only Sertoli cells, and this difference could be clearly observed under the surgical microscope. Taking larger diameter spermatogenic tubules under the surgical microscope helps to improve the detection rate of spermatozoa. This method has the following advantages over conventional biopsy: 1. An operating microscope is used during standard open diagnostic testicular puncture to confirm the absence of vascular areas within the white membrane, to minimize damage to the testicular blood supply, and to obtain a relatively bloodless biopsy specimen. 2. The use of microscope during biopsy can clearly identify relatively full spermatogenic tubules, which may have spermatozoa, thus improving the detection rate of spermatozoa. In the case of azoospermia due to “small testicles”, testicular puncture is more difficult and the probability of obtaining sperm is lower. If the success rate is low, for example, if FSH and other hormone levels are not normal, oral or injectable medications such as HCG, HMG, or direct FSH supplementation can be used to help boost sperm volume. The length of medication is determined by the size of the patient’s testicles, the wife’s age, the length of treatment acceptable to both spouses, etc. Generally speaking, surgery can be performed after six months to a year of treatment. Zhao Lianming, a male disease specialist at Peking University Third Hospital, generally has to be hospitalized for 1 to 2 days after the testicular microscopic sperm retrieval surgery, which rarely causes discomfort, does not affect sexual life, and no scarring can be seen. Microscopic sperm retrieval is the treatment with the highest chance of obtaining sperm. If sperm retrieval fails, the doctor will assess the patient’s suitability to do it again based on intraoperative conditions (such as the development of spermatogenic tubules in the testes). In between, patients are advised to make self-adjustments, such as quitting smoking and drinking, avoiding overexertion, avoiding occupational disadvantages (e.g. exposure to paint, radiation, etc.), and may be assisted with appropriate medication. However, if repeated sperm retrieval fails, IVF can only be performed through donor sperm.