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Patients with extremely severe oligozoospermia (ESO)and cryptozoospermia (CO) are suitable using intracytoplasmic sperm injection (ICSI) as infertility treatment.However, some andrologists are confused to distinguish ESO and CO in clinic diagnose.This study was designed for the first time to evaluate and compare patients with ESO and CO to determine whether these are useful clinical distinctions.A total of 270 infertile men in our center were classified four groups: group non obstruction azoospermia (NOA, n=44), Group ESO (n=78), Group CO (n=40) and Group obstruction azoospermia (OA, n=108).Comparisons of volume of bilateral testes, the level of follicle stimulating hormone (FSH) and inhibin B were obtained in four groups.Then comparisons of fertilization rates, cleavage rate, excellent embryos rate were obtained when couples performed ICSI.All indexes (volume of bilateral testis, level of FSH and inhibin B) in group ESO and CO was no difference, while group OA vs NOA, OA vs ESO, OA vs CO were significant differences (P<0.05).The rates of fertilization was no differences in group ESO and CO, while group OA vs ESO, OA vs CO were significant differences (P<0.05).Therefore, the spermatogenic functions in patients with CO and ESO were similar, better than NOA but worse than OA.However, it would be helpful to evaluate their spermatogenesis using testicular biopsies, especially accompanied azoospermia in clinical practice.