Ans. is a i.e. TESA Friends, we have studied in detail IVF and IUI but either of them cannot be performed if appropriate methods for sperm recovery are not available in cases of male infeility. Sperm retrieval or Recovery can be done by : Microsurgical Epididymal Sperm aspiraton : MESAdeg Percutaneous Epididymal Sperm aspiration : PESAdeg Testicular sperm extraction : TESEdeg Percutaneous Testicular sperm fine needle aspiration : TESAdeg (also called as Fine Needle Aspiration FNA). The choice of the method depends on : the underlying diagnosis, whether goal of the procedure is diagnostic or therapeutic whether, isolated sperm will be used immediately or cryopreserved. TESA Is a percutaneous method which requires No/Local anesthesia and retrieves sperms from the testis when spermatogenesis is normal as in cases of post-testicular azoospermia (i.e. either there is congenital absence or obstruction of ',as deferens/ejaculatory ducts or Retrograde ejaculation). MESA Also indicated in cases of post testicular azoospermia. It is done when one need's to know the nature of obstruction or if surgical correction of the obstruction is to be performed at the same time of sperm recovery. (Done under GA/Regional anesthesia). Another advantage of MESA is that a very large number of sperms are usually retrieved so that cryopreservation and avoidance of repeat surgery may be possible PESA Percutaneous epididymal sperm aspiration can also be used in cases of Post testicular azoosperma but it is a blind procedure. Bleeding . epididymal injury and postsurgical fibrosis can occur. TESE Indicated in men with testicular azoospermia or Gonadal failure. Intracytoplasmic sperm injection : i.e. ICSI Here a single sperm is injected into the cytoplasm of the oocyte which is then incubated over night. The procedure involves stripping of the aspirated cumulus complex of all surrounding Granulosa cells, so that micromanipulation can be performed on the egg itself. A holding pipette is used to stabilize the egg while an injection pipette is used to inse a ble sperm into the cytoplasm of the egg. Advantage : This procedure bypasses events like capacitation and acrosome reaction by the sperms. Indication : It is indicated in male factor infeiliy : When sperm is count is less than 5 million / ml (severe oligospermia). Absolute indications : asthenospermia i.e. < 5% progressive motility. Teratospermia i.e. < 4% normal sperms. No.of motile sperms is < 0.5X106/m1 (as in these conditions IUI cannot be done). If sperms lack acrosome. Abnormal sperm morphology. In cases where sperms are being surgically retrieved (as number of sperms are less). H/O 2 previous feilization failures with conventional IVF technique. GIFT : (Gamete Intra Fallopian Transfer) / ZIFT : (Zygote Intra Fallopian Transfer) They are alternatives to IVF in which oocytes and sperm (in GIFT) or zygote (in ZIFT) are transferred to fallopian tube instead of Uterus laparoscopy. Once commonly used. as they offered high success rates to women with normal tube anatomy (whereas IVF is mainly used in cases where tubal pathology is present), both procedures are relatively rare now.