In the past three decades, several changes have taken place in clinical andrology. Gradually, empirical treatments are being replaced by techniques of assisted reproduction, i.e. intrauterine insemination, in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI). In particular, the introduction of ICSI in 1992 [1, 2] has completely changed the clinical approach towards male infertility by offering a novel opportunity for parenthood even to azoospermic men. A single spermatozoon can be injected into an oocyte and result in normal fertilization, embryonic development, and implantation. Not only ejaculated spermatozoa can be used, but epididymal or testicular spermatozoa can also be used for ICSI. Testicular spermatozoa can be retrieved in some patients with non-obstructive azoospermia (NOA) because of the persistence of isolated foci of active spermatogenesis. The first pregnancies using epididymal and testicular spermatozoa in men with obstructive azoospermia (OA) and NOA were published in 1993 and 1995, respectively [3-6]. Surgical retrieval of spermatozoa for ICSI has become a routine technique in clinical andrology. Several techniques are available to retrieve epididymal or testicular spermatozoa. Although there is no real method of choice, some guidelines may be given in order to make the best choice for a specific clinical setting. ICSI has also reinforced the role of non-surgical techniques to retrieve sperm in men suffering from anejaculation.
