Sometimes no sperm is seen in the ejaculate but there may be sperm in the testes. Sperm can be extracted surgically either under local or full anaesthetic and used with ICSI for treatment. This can also be the process used if a man has had a vasectomy and a reversal has either failed or is not advised due to the length of time since the procedure. The quality of sperm can be quite fragile after extraction so in most cases it is advised to synchronize the sperm retrieval with when eggs are available to be fertilized, whether the partner’s or donor’s eggs are being used. Spare sperm can be frozen for future use should the parameters of count, motility and normal forms be acceptable.