This includes severe oligospermia, OATs (oligoasthenoteraozoospermia) and azoospermia. Azoospermia’s are tackled in a manner discussed elsewhere in the site. All such cases are sent to our male specialist who may be a surgeon or a urologist trained in male infertility (andrologist). They take history and examine the patient and correct any cause if found. Infections can be treated by antibiotics. If there is a palpable varicocele it can be surgically corrected by microsurgery or laparoscopy. Hypogonadotropic hypogonadism is treated with gonadotrophins. In this, after treatment, once the sperms are produced in the semen, they can be frozen for future use with ICSI. If there is no cause found, patient is given empirical treatment such as clomiphene, carnitine, coenzyme q, as well as gonadotrophins. If after treatment, if the count is 5-10 million/ml, one can try 2 IUI cycles followed by ICSI. If the count is < 5 mill /ml it is best to directly go for ICSI. In cases of repeated ICSI failure or sperms with very severe abnormality normal forms < 4%, one can go for picsi or imsi. Sperms can be prepared by advanced technique of microfluidics. In case of sperm DNA fragmentation of > 30 % one can correct a palpable varicocele if present or give patient oral medication with antioxidants. Following this if DNA fragmentation of > 30 persists, it is best to do TESE ICSI. While doing ICSI we have advanced technique of Spidle check, wherein we can inject the eggs after the visual appearance of spindle, on inverted microscope. We can also avoid injuring the spindle. Our unit is the pioneer in ICSI. We started ICSI in 1995 and were the fourth unit to install ICSI in India in 1995. We were also the first unit in India to install IMSI and Spindle check. Many of our units have got the advanced technique of PICSI/IMSI as well.