Objective To investigate the effects of the two different embryo transfer protocols on pregnancy and neonatal outcomes after intracytoplasmic sperm injection（ICSI）with testicular sperms in patients with obstruc⁃ tive azoospermia（OA）. Methods We retrospectively analyzed the data on the obstructive azoospermia patients who had used testicular sperms obtained by testicular sperm aspiration（TESA）for ICSI in the reproductive center of the Second Affiliated Hospital of Wenzhou Medical University from January 2017 to December 2020. According to the different blastocyst transfer protocols，these patients were divided into frozen⁃thawed embryo transfer（FET） group（n = 162）and fresh transfer group（n = 178）. The clinical data，pregnancy and neonatal outcomes were compared between the two groups. Results Under a condition of the similar average number of transferred blasto⁃ cyst，there were no significant differences in the rates of implantation rate，clinical pregnancy，multiple pregnancy， miscarriage，preterm birth，and live birth between the two groups（P > 0.05）. The mean birth weight，low birth weight rate and sex ratio at birth were similar in the two groups（P > 0.05）. The average gestation length was shorter in the FET group than in the fresh transfer group（P < 0.05）. Conclusions For patients with obstructive azoosper⁃ mia，fresh or frozen⁃thawed blastocyst transfer after ICSI⁃ET with testicular sperms has no effects on pregnancy and neonatal outcomes.