Background: Male infertility is a common problem and needs a minimally invasive method to arrive at the appropriate diagnosis. Alternative to open testicular biopsy the fine needle aspiration cytology (FNAC) of the testis is being increasingly used as a minimally invasive method of evaluating testicular function. Aim: To determine the causes of azoospermia and evaluate the efficacy of FNAC as compared to open testicular biopsy in evaluating azoosparmic men by correlating diagnosis from testis FNAC with biopsy histology. Patients and Methods: We prospectively studied 67 consecutive infertile patients who referred to andrology department of Al-Yarmouk Teaching hospital, Baghdad, Iraq between (January 2010-January 2014). All patients were azoospermic. They underwent bilateral testicular fine needle aspiration for cytological evaluation as well as bilateral testicular biopsy for histopathological correlation. Results: The morphological diagnosis revealed normal spermatogenesis in 12 patients (17.9%), hyposparmatogenesis in 4 (5.9%), spermatogenic arrest in 39 (58.2%), Sertoli cell only in 7 (10.4%), and complete tubular hyalinization in 5 patients (7.4%). Good correlation between the 2 methods was found in 120 (91.6%) testes which was identical in the right and left testis. Discrepancies between cytology and histology were mainly the result of insufficient and scanty smears. Conclusion: Testicular FNAC is a simple and minimally invasive alternative method to open testicular biopsy in the investigation and assessment of patients with azoospermia.