This chapter deals with the management of azoospermia. It is imperative to pursue in every azoospermic patient a proper diagnostic process, during which one should classify the patients according to the etiology of their azoospermia due to pretesticular, testicular, or post-testicular causes. Methods of surgical sperm retrieval (SSR) include epididymal and testicular sperm retrieval, which can be open, close, or with microdissection. Microepididymal sperm aspiration (MESA), percutaneous epididymal sperm aspiration (PESA), testicular fine-needle aspiration (TEFNA), testicular sperm extraction (TESE) are various sperm retrieval techniques. The underlying etiology of azoospermia could influence the viability of the retrieved sperm cells as well as determine their maturational status being from epididymal or testicular source, in obstructive azoospermia (OA) or nonobstructive azoospermia (NOA), respectively. Cryopreservation of the remaining testicular tissue after sperm extraction or of individual sperm cells isolated after TESE represents a technical challenge.