Azoospermia is the total absence of spermatozoa in the ejaculate. It is found in 10–15% of male infertility cases and is caused by a testicular insufficiency in the majority of patients. Obstructive azoospermia is less frequent and arises in 15–20% of men with azoospermia. Most causes of male infertility are treatable, and many treatments restore the ability to father a children naturally. In case of vasal or epididymal obstruction, microsurgical reconstruction of the seminal pathways, if possible, remains the safest and most cost-effective treatment option for these patients, allowing natural conception in many cases. Not all men with obstructive azoospermia are treatable by microsurgical reconstruction. In such situations, various sperm-retrieval techniques can be employed to take sperm for use with in vitro fertilization (IVF) via intracytoplasmic sperm injection (ICSI).