This study aim at determining the best method of testicular sperm treatment in patients with obstructive (OA) and non-obstructive azoospermia (NOA) before ICSI. The study included 664 ICSI cycle. Low fertilizing potential and clinical pregnancy with sperm of NOA in comparison to OA patients. Sperm in-vitro culture of NOA improved sperm quality to the level of OA. In-vitro cultured and frozen testicular sperm have better biological and clinical outcome in comparison to fresh sperm. Patients with favourable testicular histopathology have better biological and clinical outcome in comparison to un-favourable histopathology. The mean number of embryos frozen / cycle was higher with in-vitro cultured, frozen-thawed in comparison to fresh sperm. Frozen-thawed embryo cycles with showed no significant difference according to sperm origin.