Sperm retrieval by TESE can be performed prior to or coincident with an IVF cycle for the female partner. We have performed all initial TESE procedures on the day of oocyte (egg) retrieval during a programmed IVF cycle to maximize the potential to retrieve viable spermatozoa for use with ICSI. Therefore, the female partner must be evaluated by the IVF center before considering a TESE procedure. Since men with NOA have marginal sperm production, TESE procedures should be delayed for at least 6 months after any intervention such as a prior biopsy or TESE procedure, or other inguinal/scrotal surgery. Since the testicular blood supply penetrates the tunica albuginea and then disperses in a series of end-arteries that spread over the testicular parenchyma, multiple biopsies should be avoided to minimize the risk of devascularization of the testis. The use of optical magnification may also minimize the risk of testicular injury. We have seen two men who have had significant devascularization of the testis with atrophy after TESE performed at other centers using multiple biopsy technique.