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The method, which will be used during the fertilization procedure, depends on the nature of the problem in the male partner, which needs to be explored carefully first.

These methods are used in men who don't have sperm or who cannot ejaculate even though they produce sperm and then these sperms are used for fertilization.

• TESE (Testicular Sperm Extraction): This involves opening up the scrotum and taking a large volume of testicular tissue, perhaps from several regions of the testicle. Then, sperm are retrieved using a microscope to identify individual sperm.
• Microdissection TESE: This is a similar but more preferred technique but a microdissecting microscope is used to pinpoint the tissue to be removed. This aims to cause less damage to the structure inside the testicle, and to therefore have fewer after effects such as blood supply problems caused by tiny blood vessels being cut. It also appears to increase the number of sperm that can be retrieved.
• TESA (Testicular Sperm Aspiration): This involves placing a needle attached to a syringe through the skin of the scrotum and simply sucking out the fluid inside the testicle.
• PESA (Percutaneous Epididymal Sperm Aspiration): This involves the same needle and syringe technique but the needle is placed directly into the epididymis.
• MESA (Microsurgical Epididymal Sperm Aspiration): An open surgical sperm retrieval procedure that uses an operating microscopy to locate the tubules of the epididymis precisely, so that large numbers of sperm can be extracted.