A 39-year-old male came to our clinic on 4th October 2018 complaining not being able to conceive after 10 years of marriage. The patient denied having an erectile or ejaculation problem. He also had regular intercourse with his wife two or three times a week with no lubricant. His wife was 43 years old and had been diagnosed with uterine polyps. The patient also denied having diabetes, hypertension, history of mumps, orchitis, or undescended testes. He had a history of sperm extraction 9 years ago and no sperm was found at that time. However, 3 months prior to his visit to our clinic, the patient underwent a procedure called FNA Mapping on his testes revealing that there were several spermatozoa at specific sites of his testes (). However, the procedure was conducted in Turek Clinic, San Fransisco USA and the patient did not have any plan to stay in USA, thus the fertility program discontinued, and the sperm was not frozen. His medical history was otherwise unremarkable. Physical examination revealed that the patient had grade II bilateral varicocele. This finding was confirmed by testicular ultrasound, in which the volume of both testes was also evaluated. The volume of his right testis was 8 ml with the longest axis of 3.81 cm whereas the volume of his left testis was 4 ml with the longest axis of 2.69 cm (Confirmed with ultrasound, ). He was azoospermic with low testosterone level of 2.21 ng/ml and elevated FSH level of 15.64 mIU/ml; he had been treated with Profertil (Clomiphene citrate) and Ovutrig (Human chorionic gonadotropin) for 3 months prior to his visit to our clinic. Also, his Y-chromosome was analyzed for microdeletion and the patient had a microdeletion in the azoospermia factor (AZF)c region (). After further 6 months of hormonal therapy, the patient was still azoospermic with normal testosterone of 5.25 ng/ml and elevated FSH of 22.46 mIU/ml. The patient then underwent sperm extraction at our clinic. First, percutaneous epididymal sperm aspiration (PESA) and microsurgical epididymal sperm aspiration (MESA) were performed on both testes and no sperm was found. After that, the search for viable sperm continued by performing microTESE. Next, microTESE procedure was performed at the specific site of the testes based on the FNA Mapping result in which the sperm was previously found. The procedure was performed on 10th April 2019 (). On those sites, the largest tubules were identified and the tubules were analyzed for the spermatozoa under the microscope.