Men with no sperm at all in their ejaculate can now have their own child, because sperm can be retrieved from their testicle or epididymis and injected into their partner's eggs via intracytoplasmic sperm injection (ICSI). The highest pregnancy rates with this approach and the least pain and discomfort to the male require that these sperm retrieval procedures be performed microsurgically.
In cases where little or no sperm is found in the epididymal tubules, or when there is no epididymis, we can use testicular sperm. The success rate is similar to that with epididymal sperm. The only drawback to using testicular sperm is that it does not freeze as well. These procedures can be done under local anesthesia, in a few minutes, with very little post-operative pain.
One type of azoospermia (no sperm in the ejaculate) is non-obstructive, and this is caused by "apparent" absence of sperm production in a deficient testicle. This severe male fertility problem, caused by extremely low, or apparently no, sperm production, with no sperm reaching the ejaculate, now also has a very good chance for success using testicular sperm retrieval and ICSI.