In certain cases (i.e., blockage of the spermatic duct) there are no sperm cells in the ejaculate at all. Nonetheless, it is possible to get sperm directly from the testes (TESE/TESA testicular sperm extraction or testicular sperm aspiration).

In this procedure, tissue specimens are taken by a minor surgical procedure. These specimens, which usually contain sperm, are cryopreserved to avoid repeated procedure and later used for ICSI