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.

Plurality at birth is of prime importance and is the single most significant determinant of paediatric outcome after assisted reproductive technology (ART). The types of treatment used, such as in vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI), blastocyst transfer and others, become mere subtleties when faced with the birth of triplets. There is probably a continuum of risk between standard IVF and the more recent ICSI, with even more invasive forms of ART such as ICSI with testicular sperm aspiration (TESA) being of higher risk for the birth of children with birth defects. Doyle et al estimated that 20000 children would be required to observe a doubling or halving of the risk of childhood cancer in children conceived after ART compared with the general population. There has been some suggestion from a Swedish study that children born after IVF have an increased risk of developing neurological problems, particularly cerebral palsy.