Microdissecting testicular sperm retrieval is a further refinement of conventional testicular sperm retrieval, allowing for the effective harvesting of sperm cells from the germinal vasculature for “in vitro fertilization” – ICSI – thereby giving men with infertility who would otherwise be limited to donor sperm a last chance to have a child of their own. Although not the least invasive option, this technique ensures maximum sperm retrieval and minimal secondary damage to testicular function, provided that a minimum amount of testicular tissue is taken. This method was introduced by Schlegel as an effective method of testicular sperm harvesting in combination with ICSI for non-obstructive azoospermia. Schlegel reported that sequential microdissecting testicular sperm retrieval improved the sperm acquisition rate from 45% to 63% of conventional sperm retrieval, and the sperm acquisition volume from 64,000/720 If a prior testicular puncture biopsy is performed, we can determine the sperm acquisition rate based on its histopathological appearance, which we base on the degree of sperm development of the puncture biopsy specimen rather than on its cellular composition.