This chapter describes surgical methods for retrieval of epididymal and testicular spermatozoa in men with obstructive azoospermia (OA) or non-obstructive azoospermia (NOA). Either percutaneous epididymal sperm aspiration (PESA) or microsurgical epididymal sperm aspiration (MESA) can be successfully used to retrieve sperm from the epididymis in men with OA. If PESA fails to retrieve motile sperm for intracytoplasmic sperm injection (ICSI), testicular sperm aspiration (TESA) is performed at the same operative time. TESA may be performed in either OA or NOA cases. The chapter also describes sperm retrieval rates using different methods and in several clinical conditions. It presents clinical outcomes of ICSI using testicular and epididymal sperm. The clinical outcomes of ICSI using testicular sperm extracted by TESA or micro-testicular sperm extraction (TESE) in NOA are significantly lower than those obtained with either ejaculated or epididymal/testicular sperm from men with OA.