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Objective: To perform a review of the literature to assess the options for preserving fertility in patients with fertility threatening testicular injuries and their effectiveness to help guide surgeons who encounter these patients in the future., Materials and Methods: Medline, Embase and Cochrane library databases were searched using the keywords 'treatment', 'therapy', 'management', 'scrotal trauma/injury', 'testicular trauma/injury/amputation', 'fertility', and 'fertility preservation'. The inclusion criteria were studies reporting fertility preserving techniques with a history of testicular trauma with loss of one, both, or nearly all testicular parenchymal tissue., Results: Two cases of testicular sperm extraction (TESE), eight cases of testicular replantation, and one case of cryopreservation after injury were identified. Presence of viable sperm after surgery was found in five of 11 patients. Common reasons for failure of replantation were prolonged ischaemic time and extensive crush injury to the vascular supply of the testis. Both cases of TESE and the single cryopreservation case obtained viable sperm., Conclusion: Scrotal trauma with threat to fertility is rare. It is important that urologists should consider fertility in any situation where complete or a large amount of testicular tissue loss is at risk of occurring and offer fertility preservation options as locally available., (© 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.)