This chapter describes surgical methods for retrieval of epididymal and testicular spermatozoa in men with obstructive azoospermia (OA) or non-obstructive azoospermia (NOA). Either percutaneous epididymal sperm aspiration (PESA) or microsurgical epididymal sperm aspiration (MESA) can be successfully used to retrieve sperm from the epididymis in men with OA. If PESA fails to retrieve motile sperm for intracytoplasmic sperm injection (ICSI), testicular sperm aspiration (TESA) is performed at the same operative time. TESA may be performed in either OA or NOA cases. The chapter also describes sperm retrieval rates using different methods and in several clinical conditions. It presents clinical outcomes of ICSI using testicular and epididymal sperm. The clinical outcomes of ICSI using testicular sperm extracted by TESA or micro-testicular sperm extraction (TESE) in NOA are significantly lower than those obtained with either ejaculated or epididymal/testicular sperm from men with OA.

This chapter focuses on various issues in the cryopreservation of surgically retrieved sperm. When the male partner is unable to produce an adequate amount of ejaculated sperm with good quality for intracytoplasmic sperm injection (ICSI), surgical sperm retrieval is indicated. Various techniques have been described and modified for sperm retrieval since the introduction of ICSI. The three principal sources of sperm are epididymides, testes, and ejaculation. The quantity of sperm retrievable surgically from the epididymides and testes is generally small compared with the amount of ejaculated sperm. With epididymal sperm, there are reductions in the concentration of viable spermatozoa as well as a significant decrease (by 50%) in the percentage of motile spermatozoa. For men with azoospermia, cryopreservation of sperm retrieved surgically in advance of the fertilization stage can allow better planning for the ICSI cycle and minimize unnecessary ovarian stimulation.