fna was used to determine which men were candidates for ivf-icsi and to guide sperm retrieval procedures. sperm retrieval guided by prior fna maps was proposed as an alternative to standard sperm retrieval, which is generally performed on the same day as ivf and is associated with a significant chance of sperm retrieval failure. in 19 azoospermic men, sperm retrieval guided by prior fna mapping found sufficient sperm for all eggs at ivf in 95% of cases. in addition, fna-directed procedures enabled simple percutaneous fna sperm retrieval in 20% of cases, and minimized the number of biopsies (mean 3.1) and the volume of testicular tissue (mean 72 mg) taken when open biopsies were required. testis sparing procedures are particularly important in men with atrophic or solitary testes, and sperm retrieval guided by information from prior fna maps can conserve testis tissue. thus, this study confirmed that fna maps can accurately identify azoospermic patients who are candidates for sperm retrieval and icsi. in addition, it demonstrated that fna maps can provide crucial information with respect to the precise location of sperm in the testis and can minimize the invasiveness of sperm retrieval. currently, two kinds of maps are performed in the evaluation of azoospermic infertile men. a compound map (>4 sites/testis) is typically performed as a diagnostic test to find sperm in failing testes. for this indication, men have testis atrophy, an elevated serum follicle stimulating hormone (fsh) level, or a prior biopsy revealing abnormal or absent spermatogenesis. a simple map (< 4 sites/testis) is used to confirm the clinical expectation of sperm production in men who may be obstructed and azoospermic. simple fna maps are offered to those who are planning to have reconstructive procedures (e.g., vasovasostomy) or sperm aspiration from the epididymis and who desire more complete information about spermatogenesis before proceeding with reconstruction or sperm retrieval. regardless of the type of map, these procedures are generally diagnostic in nature. an experienced cytologist has a much better chance of finding sperm on a stained testis-tissue specimen with its higher resolution than does an andrology lab technician looking at the same tissue as part of a sperm retrieval procedure in an unstained specimen. biology of sperm production from a comprehensive study of 118 consecutive azoospermic, infertile men who underwent fna mapping, much has been learned about the geography of spermatogenesis in both normal (obstructed) and abnormal (nonobstructed) testes. in men with obstructive azoospermia, sperm is found in all sites and in all locations on the fna map. however, in men with nonobstructive azoospermia, sperm is found in about 50% of cases. in the subgroup of men with no sperm on a prior testis biopsy, fna maps revealed sperm in 27% of cases. this increased sensitivity in sperm detection is likely due to sampling a larger volume of the testis. there was also an intratesticular (site-to-site within the same testis) variation in sperm presence in 25% of cases and an intertesticular (side-to-side in the same individual) discordance rate of 19%. this suggests that bilateral examinations are crucial to fully informing men with nonobstructive azoospermia about opportunities for fatherhood, fna mapping has also been used to determine whether particular geographic sites are more likely to have sperm than others. in one study, individual testis maps from each side were pooled, and from this analysis all fna sites showed sperm at about the same frequency; there was no suggestion of sperm "hot spots" in nonobstructive testes. thus, fna mapping is a valuable diagnostic tool that not only guides the treatment of infertile men but can also provide a wealth of phenotypic information about the infertility condition. although the correlation of testis fna cytology to testis biopsy histology is clear in the literature, how do the global organ findings from testis fna mapping compare to biopsy histology? in other words, what is the chance of finding sperm on the map with each specific biopsy pattern? in a study of 87 patients, in whom a mean of 1.3 biopsies and 14 fna sites were taken per patient, striking correlations were observed between fna and histological results. overall, sperm was found by fna mapping in 52% of nonobstructive azoospermic patients. pure histologic patterns of sertoli cell-only and early maturation arrest were associated with a very poor likelihood of sperm detection (4–8%). in contrast, patients with other pure pattern histologies or mixed patterns had high rates of fna sperm detection (77–100%). thus, sperm detection with fna showed wide variation depending on testis histology. in addition, certain histologic patterns may reflect a more global testicular dysfunction due to underlying genetic causes, and thus a poorer likelihood of sperm identification. testis fna "mapping" in the treatment of severe male infertility in cases of infertility due to nonobstructive azoospermia, surgical sperm retrieval for ivf-icsi is successful 40–60% of the time without prior knowledge of the geography of testis sperm production. with the addition of diagnostic fna mapping, the rate of successful sperm retrieval can be increased substantially. in addition, based on sperm quantity and distribution in the testes as assessed by the map, sperm retrieval can proceed from the least invasive to the most invasive methods. from a review n=159 cases of nonobstructive azoospermia, one group observed that 44% of mapped cases required sperm retrieval by needle aspiration (tesa); 33% required open, directed surgical biopsies (tese); and 23% needed microsurgically-assisted dissection of the entire testis parenchyma (mtese) for successful sperm retrieval. in addition, the majority (78%) of these cases required only unilateral sperm retrieval to find sufficient sperm for ivf-icsi. overall, sufficient sperm for all oocytes retrieved was possible in 95% of cases with prior maps, ranging from 100% in simple aspiration cases to 80% of microdissection cases. in addition, among men who underwent a second sperm retrieval procedure, sperm was successfully retrieved in 91% of attempt; and among patients who had a third sperm retrieval, sperm was retrieved in 100% of attempts. thus, knowledge of sperm location with fna mapping can simplify and streamline sperm retrieval procedures in very difficult cases of nonobstructive azoospermia. summary testis fna cytology of the testis correlates well with testis biopsy histology in the evaluation of male infertility. testis fna cytology is rapid and safe and provides information not only on the presence or absence of sperm but, when applied in multiple areas like a "map", can precisely localize sperm production. testis fna cytology can direct sperm retrieval procedures and minimize the amount of testicular tissue removed. with wider sampling of the testis achieved with fna cytology, the heterogeneity of sperm production can be more accurately defined and sperm retrieval procedures improved. although assessment of architecture and the basement membrane is not possible with fna, whole organ cytologic examination of seminiferous tubule patterns with mapping provides useful phenotypic information about severe male factor infertility. footnotes posner c. die diagnostische hodenpunktion. berl klin wochenschr 1905;42b:1119-1121 hendricks fb, lambird pa, murph gp. percutaneous needle biopsy of the testis. fertil steril.1969; 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