Objectives: The discovery that azoospermic men with germinal failure often have tiny foci of intact spermatogenesis somewhere in their testes has brought hope that these men could now father a child by virtue of testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). There has also been some hope expressed that early round spermatids could be found and used for ICSI in patients who have no sperm recoverable. We wish to present our results and our analysis.Method: 74 men with non-obstructive azoospermia caused by germinal failure underwent TESE-ICSI. Results were analyzed by the particular testicular pathology, by the age of the wife, and by the presence or absence of sperm or round spermatids in the testes.Results: Spermatozoa and elongated spermatids were recoverable in 46 (62%) of the 74 azoospermic couples. Neither embryo transfer rate (58%), 2PN fertilization rate (39%), cleavage rate (81%), nor the delivered pregnancy rate (23%) per initiated cycle was affected by whether the pathology was Sertoli cell only, maturation arrest, postchemotherapy, or cryptorchid atrophy.The delivered pregnancy rate per cycle, (and the delivered pregnancy rate per cycle with sperm found) was not related to the quality or the quantity of sperm recovered. However, it was related directly to the age of the wife. The delivered pregnancy rate for all cycles in which sperm were recovered was 37%. For women under 33 years, the delivered pregnancy rate was 44%; for women 33 to 36 years, it was 33%; for women 37 to 39 years, it was 16%; there were no pregnancies in women 40 and older.In the 28 men (38%) in whom no sperm was found at TESE, round spermatids were not found, either in the TESE procedure itself, or in a subsequent examination of histologic sections. Round spermatids were never found in the absence of elongated spermatids or sperm.Conclusions: 1) The specific pathology of azoospermic germinal failure (Sertoli cell only, mauration arrest, cryptorchidism, etc.) had no effect on the likelihood of finding sperm with TESE-ICSI or on the pregnancy rate; 2) The age of the wife did significantly affect the pregnancy rate (but not fertilization or embryo cleavage); 3) In the absence of elongated spermatids or sperm, round spermatids could not be found.