Background: Aims: The objective of this study was to assess the diagnostic accuracy and cytological features of fine needle aspiration cytology smears (FNAC) in determining the causes of azoospermia as compared to open testicular biopsy. Methods: 35 patients with non-obstructive azoospermia were subjected to the study; the age of them was 20-40 years. Each patient was subjected to the taking history and clinical examination. Laboratory tests were done including urine analysis, three consecutive semen samples and endocrine evaluation. Then, cord block was achieved with 1% lignocaine; and fine needle aspiration was be done, then staining the smears with Leishman or hematoxylene and eosin stains. In the same sitting, testicular biopsy was taken, then Hematoxylin & Eosin (H&E)-stained sections were prepared. Histopathological and cytological evaluation was investigated; and photographs were be taken. Then, statistical analysis was performed. Results: The concordance of FNAC with open biopsy in the diagnosis of azoospermia was 100%. FNAC smears was associated with fewer complications such as bleeding, pain and hematoma than in case of open biopsy. Conclusion:The technique of testicular FNAC is simple, more than one specimen could be taken safely. FNAC is representative and correlates well with testicular biopsy histology.