This abstract outlines the procedures and techniques used to harvest testicular spermatozoa. The chapter begins with a brief description of testicular anatomy and methods for harvesting sperm from men with obstructive azoospermia, which is usually less challenging compared with nonobstructive azoospermia (NOA). Various approaches for sperm recovery in NOA are discussed, with special emphasis on the techniques, their safety, and efficiency in sperm retrieval. The chapter also addresses clinical decision-making in surgical sperm retrieval, including an algorithm to guide urologists and andrologists in performing microdissection testicular sperm extraction. Finally, it compares surgical sperm retrieval techniques in terms of pregnancy and live birth rates. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2026.