The severe cases of male infertility such as anejaculation, the absence of sperm on semen analysis may be due to azoospermia, congenital bilateral absence of the vas deferens, vasectomy or no viable sperm after ejaculation. To overcome severe male infertile problem there are treatment options depending on the sperm source available and patient preference such as the following:

• • Percutaneous Epididymal Sperm Aspiration (PESA): This is the technique that sperm are aspirated from the epididymis through the skin
  • Testicular Sperm Aspiration (TESA): This technique collects sperm from the testicle by needle aspiration
  • Testicular Sperm Extraction (TESE): This is an open surgical biopsy technique to remove a few testicular tissues and extract to find the sperm.

As there are very few amounts of sperm from these retrieval techniques, the doctor will recommend the patients to undergo ICSI for the higher chance of fertilization. Unfortunately, if there is a problem identified that the testicles are incapable of sperm production, we may retrieve premature sperm subsequent to rather low success rate.