Nonobstructive azoospermia (NOA) associated with impaired sperm production is a condition that is diagnosed when no sperm are found in the ejaculate. In order to have children, men with NOA require testicular sperm retrieval along with intracytoplasmic sperm injection (ICSI). The process of extracting sperm from individuals with NOA is more challenging and may require additional steps before microinjection into oocytes, compared to sperm from non-azoospermic or obstructive azoospermic males. A significant difficulty in obtaining sperm in NOA cases is the tendency for testicular sperm to be nonmotile and scarce. For this reason, during the entire process of handling this type of sample, special attention must be paid to the recovery methods, temperature, culture media used, sperm capacitation, and the appropriate sperm selection, which allow us to obtain the best sperm that guarantee greater fertilization possibilities when applying ICSI. This chapter will focus on the technical aspects necessary to approach the seminal samples and ART application in these NOA patients.