Objective: The aim of this study is to compare fresh versus frozen-thawed TESE-ICSI in Egyptian men with NOA regarding fertilization and pregnancy rates. Moreover, the study aimed at finding the effect of testicular sperm motility on various ICSI outcomes.  Study Design: A case control nonrandomized study Materials and Methods: The study was approved by the medical ethical committee of the Faculty of Medicine, Alexandria University. It was conducted on 226 consecutive TESE-ICSI cycles that were performed at El Shatby ICSI center Alexandria university, Egypt, between October 2017 and August 2018. Patients suffering from non-obstructive azoospermia were included in the study. Patients with history of negative testicular biopsy were excluded from the study. In addition, female partners with uncorrected uterine pathology and those with history of recurrent implantation failure were also excluded. The decision of fresh or frozen TESE was taken according to logistic factor (the availability of the andrologist). Samples were either directly used for ICSI or cryopreserved.  Results: 63 fresh TESE and 163 frozen-thawed TESE ICSI cycles were performed. The fresh and the frozen-thawed TESE groups had comparable fertilization (67% and 55% respectively, p=0.101) and clinical pregnancy rate (42.6% and 39% respectively, p= 0.647). The clinical pregnancy rate increased significantly when motile versus immotile sperms (49% Vs 15.4% respectively, p <0.001*) were used for injection.  Conclusion: ICSI cycles injected by fresh or frozen- thawed TESE have comparable fertilization and clinical pregnancy rates. However, injected oocytes with motile sperms leads to significant increase in fertilization and clinical pregnancy