Objectives: Azoospermia secondary to neurogenic anejaculation is a relatively infrequent cause of male factor infertility. This can be secondary to diabetes mellitus, radical retroperitoneal surgery, multiple sclerosis, or idiopathic. This condition has recently been treated with alpha-adrenergic agonists, vibratory therapy, and electroejaculation. All of these means are aimed at stimulating the sympathetic nervous system to deliver an ejaculate. Vasal sperm aspiration has also been described as a means of obtaining sperm for in-vitro fertilization (IVF).Design: Sperm counts, concentrations, motility, forward progression, and conception rates were analyzed and compared to data of recent studies with electroejaculation. The sperm were then used in attempts at assisted reproductive technology (ART).Materials and Methods: Eleven men underwent a total of fifteen vasal sperm aspirations for the purposes of use with ART and cryopreservation. Eight men with neurogenic anejaculation secondary to retroperitoneal surgery (5), diabetes (1), spinal injury (1), and idiopathic (1) who were aspirated had failed medical intervention and had documented spermatogenesis. Three men had known vasal obstruction. The technique employed involves gaining control of the vas deferens through a high scrotal incision, gently massaging the proximal vas and epididymis then aspirating sperm. The vas is closed with microsurgical technique. The specimen are then given to the IVF team for use with ART. The technologies employed in the study were intra-uterine insemination (2), intracytoplasmic sperm injection (4), gamete intra-fallopian tube transfer (2), and in-vitro fertilization (4).Results: All fifteen aspirates successfully rendered sperm of adequate quality for cryopreservation or ART. The average total sperm count was 42 10 6 (range .5 - 252 10 6 ). The average sperm concentration was 24.3 10 6 (range .3-96 10 6 ). The average motility of the sperm was 73.4% (range 16-100%). The average forward progression was 82.7% (range 20-100%). Twelve procedures proceeded directly to ART. Six of the twelve attempts resulted in clinical pregnancies: three live births, two on-going pregnancies, and one ectopic pregnancy. The remaining three men had sperm cryopreserved for future use. These results compare favorably to results using electroejaculation. No complications were reported in the series.Conclusions: Vasal sperm aspiration offers a means of direct and safe access to sperm through an outpatient surgical procedure. This technique can aid in obtaining sperm for ART in those patients with documented spermatogenesis who have failed medical therapy and vibratory stimulation. The technique has also been successful in patients who have failed electroejaculation or who have contraindications to its use. The sperm obtained from this series have a higher motility and forward progression than those of recent electroejaculation series. With the success in attaining pregnancies with vasally aspirated sperm, this technique offers the urologist with a safe and efficacious means of obtaining sperm for ART in patients with neurogenic anejaculation and iatrogenic ductal obstruction.