Surgical sperm retrieval (SSR) is used in situations where sperm suitable for fertility treatment cannot be obtained by other means, principally from the ejaculate. Even sperm obtained from cryptozoospermic samples can be used for intracytoplasmic sperm injection (ICSI) and the major indication is therefore azoospermia. On occasion, sperm suitable for treatment cannot be recovered due to problems with ejaculation and if techniques like penile vibratory stimulation or electro-ejaculation fail in men with conditions such as spinal cord injuries, or if sperm suitable for ICSI cannot be recovered from the post-orgasm urine in men with retrograde ejaculation, then SSR may be needed. A rare indication would be an ‘emergency’ retrieval procedure where a patient cannot for psychological reasons, produce a sperm sample on the day of oocyte retrieval and there are therefore no sperm available to proceed to treatment. As an alternative to cancelling the cycle, some authors have reported success by utilising SSR, although oocyte cryopreservation would be an appropriate alternative approach. In cases of obstructive azoospermia (OA), reconstructive male genital tract surgery where applicable, should be considered. Some authors describe excellent outcomes for vaso-vasostomy particularly in situations where the interval between vasectomy and reversal is short and the female partner is young with no fertility issues [1].