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To assess the prevalence of intratubular germ cell neoplasia (ITGCN) in testicular biopsies of nonobstructive azoospermic (NOA) patients.The files of 415 NOA cases were revised retrospectively, in which the following were recorded: age, infertility duration, testicular sperm extraction (TESE), and histopathology. Suspected ITGCN slides were sent for placental alkaline phosphates (PLAP) stain evaluation.Out of 415 patients reviewed, ITGCN was confirmed in four patients (0.96%) with age range 25–35 years. These cases presented with primary infertility and unsuccessful TESE in their testicular biopsies; two of them showed severe hypospermatogenesis and two patients showed germ cell arrest.NOA patients should be subjected to testicular biopsy evaluation for CIS, especially for the patients at high risk, to allow earlier detection of such threatening conditions. Also, it is recommended for proved CIS patients to have a biopsy from the other side.