Collecting semen for sperm cryopreservation is generally obtained by masturbation. For many men, this may be an embarrassing or uncomfortable process (Williams [261]). It is critical that men understand how to collect semen and that they are offered a private and relaxing environment in which to do so.

For adolescent males, careful counselling as well as tactful and age‐appropriate instructions are necessary, as these patients are at risk for emotional distress from this process (Crawshaw and Hale [38]). Parents should be included in discussions, although separate sessions with the adolescent are often useful. Unfortunately, no guidelines exist on the best approach to semen cryopreservation in adolescent males, but individual institutional strategies are available.

In some patients who have suffered a spinal cord injury, ejaculation by masturbation is not an option for sperm collection. In this case, the ejaculatory nerves can be electrically stimulated using a low‐voltage rectal probe. This is usually sufficient to produce a semen ejaculate, although the quality of the ejaculate is often less using this method compared to masturbation (Brackett et al. [21]).

Microepididymal sperm aspiration (MESA) is a surgical procedure for collection of sperm when the ejaculatory tubes are blocked or have been interrupted by previous vasectomy (Bernie et al. [11]). A surgical incision is made into the outer covering of the testis and the epididymis is exposed; expanded areas of the epididymis likely to contain sperm are incised and the sperm is extracted (Bernie et al. [11]).

Percutaneous epididymal sperm aspiration (PESA) is a variant of MESA; rather than an incision, needle aspiration is used to extract sperm from the epididymis. PESA can be performed under local anaesthesia, but it is often the case that less sperm is collected using this approach (Esteves et al. [57]). Both MESA and PESA yield enough sperm for use with assisted reproductive techniques (ARTs) but not enough for a standard insemination (Bernie et al. [11], Esteves et al. [57]).

For men who have a low sperm count, recovery of sperm from the epididymis may not be successful (Dabaja and Schlegel [39]). Testicular sperm extraction (TESE) and possibly tissue biopsy may be the best option for collecting sperm suitable for ARTs. The outer covering of the testicle is pulled back so that the seminiferous tubules can be visualized. An enlarged tubule is cut to permit sperm to flow from the tubule, where it can be aspirated (Schlegel [219]). Testicular tissue can be dissected in a culture dish and the released sperm collected for ARTs (Dabaja and Schlegel [39]). Some men with permanent azoospermia after chemotherapy can be successfully treated by TESE and intracytoplasmic sperm injection (ICSI) (Meseguer et al. [143]).