Bladder exstrophy (BE) is a devastating congenital abnormality of the urinary tract in which infants are born with the urinary bladder extruded through their abdominal wall, a urethra that is open dorsally, and significant secondary abnormalities of the genitalia. We present a male patient with BE who suffered from infertility and after a long course of failed attempts with assisted reproductive technology ultimately benefitted from a synchronous testicular sperm extraction. We review the literature surrounding assisted reproductive techniques in the setting of bladder exstrophy and comment on innovative technologies that may benefit this population.