During the past 5～10 years, very few medical fields have changeddramatically as reproductive medicine, especially for the new treatment for the maleinfertility by the use of intracytoplasmic sperm injection (ICSI) techniques andadvanced surgical epididymal and testicular sperm retrieval techniques. Those twomajor technical advances have completely changed the treatment for previouslyuntreatable testicular failure (non-obstructive azoospermia), ejaculatory failure orun-reconstructable obstructive azoospermia. Many men with even the most severe formsof infertility that are not amendable to specific medical and surgical treatmentscan now have chances to father biological children with only a few of theirspermatozoa. This review serves to discuss the various advanced sperm retrievaltechniques available for assisted reproduction, with specific focus on the technicalaspects and safety. Each technique has its specific medical indications, efficacies