This chapter focuses on various issues in the cryopreservation of surgically retrieved sperm. When the male partner is unable to produce an adequate amount of ejaculated sperm with good quality for intracytoplasmic sperm injection (ICSI), surgical sperm retrieval is indicated. Various techniques have been described and modified for sperm retrieval since the introduction of ICSI. The three principal sources of sperm are epididymides, testes, and ejaculation. The quantity of sperm retrievable surgically from the epididymides and testes is generally small compared with the amount of ejaculated sperm. With epididymal sperm, there are reductions in the concentration of viable spermatozoa as well as a significant decrease (by 50%) in the percentage of motile spermatozoa. For men with azoospermia, cryopreservation of sperm retrieved surgically in advance of the fertilization stage can allow better planning for the ICSI cycle and minimize unnecessary ovarian stimulation.