In vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) have revolutionised the treatment and prognosis of oligo-terato-asthenozoospermia (OTA). Sperm extraction in the vas deferens, the epididymis (MESA: with epididymal sperm aspiration) or the testicles (TESE: with testicular sperm extraction), associated with ICSI, can achieve pregnancy in cases of excretory or secretory azoospermia. We report the results of the use of MESA and TESE in 42 patients with an average age of 37 (age range 24 to 58). Of these, 26 have excretory azoospermia, 11 secretory azoospermia and 5 a problem linked to ejaculation. Of the 506 oocytes that were inseminated, 270 zygotes were obtained, giving a fertilisation rate of 53.4%. 85 embryo transfers were carried out (55 with fresh embryos and 30 with cryo-preserved embryos). Three spontaneous abortions and one extrauterine pregnancy were reported. Six pregnancies are developing normally. To date, 13 children have been born (9 boys and 4 girls) in 10 deliveries (7 single children and 3 sets of twins). The limits of male infertility need to be revised to take these new forms of therapy into account and patients should be advised on the new possibilities available.