Objective: To assess the pregnancy outcomes of intracytoplasmic sperm injection (ICSI) in a sample of Saudi men with obstructive (OA) and nonobstructive (NOA) azoospermia. Methods: A retrospective cohort study was undertaken between August 2004 and December 2012. The study was conducted in the Reproductive Endocrinology and Infertility unit at the department of Obstetrics and Gynecology, King Abdul-Aziz Medical City and King Fahd National Guard Hospital. A total of 136 ICSI cycles (6 in OA group and 130 in NOA group) with thawed-frozen spermatozoa was included in the study. Data on demographic and clinical characteristics of couples were collected such as age, number of cycles, clinical pregnancy, fertilization, and implantation. Results: 43.4% of the cycles performed had the first ICSI attempt, and 72.8% had primary infertility. Male gender was the most common cause of infertility (96.3%). It was noted that the pregnancy rate was 10.8% [14] in the NOA group, while none (0.0%) of the OA group had a positive pregnancy. Of 14 pregnancies in the NOA group, 8 (57.1%) had successful live birth. Primary infertility was more common in NOA than in OA (74.6% vs. 33.3%), conversely secondary infertility was less common in NOA than in OA (66.7% vs. 25.4%, P value=0.047). The fertilization rate was not different between the two groups. Conclusions: This is the first hospital-based examinations of ICSI outcomes in Saudi Arabia. The study failed to present statistical evidence that the ICSI outcomes, including fertilization rate and clinical pregnancy, differ between the two types of azoospermia in the Saudi population.