Although the introduction of Intracytoplasmic Sperm Injection (ICSI) has reduced its use, microsurgical reconstruction of the seminal tract (vaso-vasostomy and vasoepididimostomy) still yields optimal results in Obstructive Azoospermia (OA), with patency and pregnancy rates around 70-95% and 20-60% respectively. ICSI has in fact allowed the use of many techniques of sperm retrieval in azoospermic patients willing to father their own children. In particular in OA the andrologist has the opportunity to choose between percutaneous (PESA, TESA) and open surgical (MESA, Mini-MESA, TESE) techniques. The former are easy and quick to perform but usually yield a poor sperm retrieval, rarely sufficient for freezing. The second are a little bit longer and more invasive but allow a conspicuous sperm retrieval and freezing with no need for further surgery. In case of Non-Obstructive Azoospermia (NOA) the only effective way to retrieve sperm for ICSI is to perform a testicular biopsy and to extract sperm from the testicular parenchyma. Recently the new microsurgical technique of Microdissection TESE (Schlegel, 1998) seems to have reduced the postoperative complications and permanent sequelae of multiple biopsies with very little testicular parenchymal loss. In our center 450 azoospermic patients underwent sperm retrieval for ICSI or for freezing in the last ten years. Sperm retrieval rate was 100% and 58% in OA and NOA respectively. Sperm retrieval rate in NOA was not significantly different when using conventional multiple biopsies-TESE or Micro-TESE. However, Micro-Tese seems to have reduced postoperative pain and complications.