In extreme cases of male factor infertility where either the sperm count is too low, they have abnormal morphology, sperms are only available through a testicular biopsy or the available sperms are immotile. Such cases present a unique challenge as these sperms by themselves are incapable of fertilizing the ovum. The doctor with the help of a high powered inverted microscope equipped with a micro manipulator attempts to choose the right sperm which is subsequently tested to confirm its viability and then injected into the oocyte in order to create an embryo.