Despite improvement in success of IVF, reproductive surgery will remain an important option and complement to assisted reproductive technologies (ART).  New surgical technique of testicular microdissection (microTESE) using high-powered operative microscope to avoid blood vessels and identify and selectively remove those seminiferous tubules that contain sperm not only provides better sperm recovery compared to simple or multiple blind testicular biopsies, but minimising damage to or loss of testicular tissue and reducing complications. Such approach has helped many men with non-obstructive azoospermia to conceive their biological children through ART. Reproductive surgery should be considered as the first-line treatment when the correction of infertility pathologies is simple and a good result is expected once corrected, when the pathology is causing symptoms such as pain or abnormal bleeding or if uncorrected will compromise the results or increase the risks of ART.  The success of surgical infertility treatment depends on the optimal selection of cases using appropriate investigative techniques, carefully follow microsurgical principles to conserve normal tissues and avoid adhesion formation, with procedures performed in centres with sufficient expertise.  Endoscopic approach has many inherent microsurgical advantages which offers improved results, safety, cost-effectiveness and quicker recovery times.  Most of the female reproductive microsurgical procedures that traditionally required laparotomy can now be performed endoscopically on a day surgery basis.