FERTILITY AND REPRODUCTIVE MEDICINE CENTER: Edited by Peter N. Schlegel and Craig NiederbergerModern surgical treatment of azoospermiaBrant, Aarona; Schlegel, Peter N.a,b Author Information aDepartment of Urology bCenter for Reproductive Medicine and Infertility, Weill Cornell Medical College, New York, New York, USA Correspondence to Peter N. Schlegel, James J. Colt Professor of Urology, Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY 10065, USA. Tel: +1 212 746 5491; fax: +1 212 746 8425; e-mail: [email protected] Current Opinion in Urology: January 2023 - Volume 33 - Issue 1 - p 39-44 doi: 10.1097/MOU.0000000000001055 Buy Metrics Abstract Purpose of review To review noteworthy research from the last 2 years on surgical management of azoospermia. Recent findings The recommended treatments for nonobstructive and obstructive azoospermia have not appreciably changed. However, recent level-1 evidence has reinforced superiority of micro-dissection testicular sperm extraction over sperm aspiration in men with nonobstructive azoospermia, and several studies have identified genetic and other clinical factors that may aid in selecting candidates for testicular sperm extraction. Machine learning technology has shown promise as a decision support system for patient selection prior to sperm retrieval as well a tool to aid in sperm identification from testis tissue. Summary Most men with obstructive azoospermia who desire fertility can be offered either surgical reconstruction or sperm retrieval. For men with nonobstructive azoospermia, sperm retrieval with microdissection testicular sperm extraction remains the gold standard treatment. Uncovering more genetic causes of nonobstructive azoospermia may aid in properly counseling and selecting patients for microdissection testicular sperm extraction. Neural networks and deep learning may have a future role in patient selection for surgical sperm retrieval and postprocedural sperm identification. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.