Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 15 4 2021 11 28 262 265 Nahathai Paktinun Bumrungrad International Hospital, Bangkok, Thailand Chartchai Srisombut Bumrungrad International Hospital, Bangkok, Thailand Thidarat Kongwattanasin Bumrungrad International Hospital, Bangkok, Thailand Krit Pongpirul Bumrungrad International Hospital, Bangkok, Thailand AND Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand AND Johns Hopkins Bloomberg School of Public Health, Baltimore, USA 2021 01 07 2021 08 17 Objective: Sperm donation and hormonal therapy with micro-Testicular Epididymal Sperm Extraction (TESE) for infertility from testicular failure might not always be available in some contexts. We report a successful embryo transfer from the patient-by ‘cumulative sperm collection’ strategy. Case report: A 42 year-old male presented with non-obstructive azoospermia from testicular failure. Hormonal treatments were given along with the patient-initiated ‘cumulative sperm collection’ strategy, which eventually resulted in 17 sperms retrieved. Twelve mature oocytes were selected for intracytoplasmic sperm injection (ICSI) with the retrieved sperms, of which 8 oocytes were successfully fertilized but only two reached the early blastocyst stage; the first embryo transfer was not successful. Another five eggs were thawed and fertilized with the remaining 5 sperms and 3 oocytes were successfully fertilized: Seven cells were grade 3, 6 cells were grade 3, and 3 cells were grade 3. The second embryo transfer was successful, and the term female infant was successfully delivered by cesarean section. Conclusion: At a center without micro-TESE availability, successful embryo transfer for testicular failure type IV could be achieved by hormonal therapy plus a ‘cumulative sperm collection’ strategy. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1668 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/1668/583