Abstract
About one in six men with infertility has azoospermia, defined as the complete absence of sperm in the ejaculate. Obstructive azoospermia is an important diagnostic category since a number of these cases can be treated surgically. Microsurgery is currently offered for bypassing an obstruction in the epididymis or the vas deferens and for correction of a varicocele. The evaluation and investigations are tailored to diagnose suitability for microsurgery and maximize successful outcomes. Vaso-epididymal anastomosis, vasovasostomy, and microsurgical varicocele ligation are the most common microsurgical procedures performed for male infertility. There are variable success rates depending on the etiology, patient selection, and surgical technique. Simplified procedures can help increase acceptability and practice of these procedures.