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This chapter provides a comprehensive review of the available techniques for sperm retrieval, along with a brief description of the subtleties of each surgery. It describes the assessment of the outcomes associated with the various sperm retrieval techniques, based on the available literature. As in the obliterative microsurgical epididymal sperm aspiration (MESA) technique, inspection of epididymal tubules begins at the cauda and progresses proximally toward the head of the epididymis. Percutaneous epididymal sperm aspiration (PESA) may be performed to obtain sperm for in-vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI). It can be done with a local anesthetic in an office setting. For cases of severe male-factor infertility such as nonobstructive azoospermia, or for obstructive azoospermia, testicular sperm may be used for IVF/ICSI. In the setting of normal spermatogenesis and vasal obstruction, either iatrogenic or congenital, sperm may be aspirated from the lumen of the testicular end of the vas deferens.