Varicocele repair and testicular sperm extraction (TESE) are most commonly performed for infertile males. Generally, TESE is performed to retrieve spermatozoa in azoospermic patients, and varicocelectomy is used to restore the possibility of spontaneous pregnancy by recovering sperm parameters. Most recently, indications for these treatments have been extended with the spread of intracytoplasmic sperm injection (ICSI). To decrease the DNA damage of spermatozoa, TESE for severe oligozoospermia and varicocelectomy for azoospermia or severe oligozoospermia are considered treatment options. However, there is insufficient data with which to draw conclusions about the efficacy of these treatments; the outcomes appear to show improvement to some extent. To achieve a successful ICSI outcome for the improvement of male factor infertilities, these treatments should be offered to selected patients. During selection, patients, especially those with severe oligozoospermia who frequently have a genetic disorder should undergo genetic analysis before treatment.