Non-obstructive azoospermia can be described as a heterogeneous group of diseases whose common etiology is impaired spermatogenesis in the testicles. NOA is responsible for about 15% of male infertility. The development of surgical isolation of sperm from the testicles has made it possible for men with NOA to have children. Pregnancy in these couples is achieved through a combination of in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and isolated sperm. Extraction of sperm from the scrotum can be performed percutaneously with a needle (TFNA) or through an open surgical approach. TFNA is now used as an additional technique to map preserved spermatogenesis in the testes before the open surgical biopsy. An open biopsy can be performed with the help of microscopic magnification (mTESE) or without optical apparatus (cTESE). Complications after the procedure are rare and include intratesticular hematomas, a drop in testosterone levels, and impaired testicular integrity with seminal tissue atrophy. Today's gold standard in sperm isolation is mTESE. Many studies have shown its advantage in the success of sperm extraction (SRR) and fewer postoperative complications. The success of sperm isolation can be potentially influenced by men's age, sperm volume, and genetic background. Their predictive values are not unambiguous, and for now, they are not used as indicators of the success of sperm isolation. Although the benefits of mTESE are known, further, well-designed studies are needed to determine the true differences between the surgical techniques.