If you have the following clinical manifestations: normal semen volume but no sperm detected, normal testicular size, normal blood folliculopoietin (FSH) and testosterone levels, bilateral epididymis enlargement, testicular biopsy results showing normal spermatogenesis, what is the preliminary diagnosis of obstructive azoospermia and epididymal obstruction? At present, the internationally accepted treatment for this type of disease is either assisted reproductive technology or surgical treatment (microscopic reconstruction of the vas deferens and epididymis), how do I choose between the two? Epididymal obstruction can be as high as 3-6% of male infertility patients, so its treatment has a very important role in male infertility. The vas deferens epididymal duct micro reconstruction technique has undergone continuous improvement through end-to-end vas deferens epididymal duct anastomosis, end-to-side anastomosis, triangular three-needle overlay anastomosis, transverse and longitudinal double-needle overlay vas deferens epididymal anastomosis, etc., and the efficacy has been continuously improved. Longitudinal double-needle stacked vas deferens anastomosis is a major technical breakthrough since the first microsurgical vas deferens anastomosis was started in 1978, and now it has become the preferred technique for vas deferens anastomosis in Europe and America. Unlike the technique of directly suturing the vas deferens to the epididymal section that is still used in many hospitals in China, the double needle overlay anastomosis is a microscopic overlay anastomosis of a single epididymal duct (usually only 0.3-0.5mm in diameter) to the vas deferens with a 10-0 micro nylon thread, and is therefore considered one of the most challenging microsurgical techniques. In the era of IVF, surgical treatment by male surgeons has become very important in the field of reproduction. Numerous studies have shown that microscopic reconstruction of the vas deferens epididymis has the following advantages over in vitro fertilization combined with embryo transfer (IVF)/intracytoplasmic single sperm injection (ICSI) methods: 1. Patients can obtain offspring through natural conception, avoiding possible ethical and moral issues and reducing the risk of multiple births; 2. Cost-effective, i.e., low cost per offspring obtained, in what is still a developing country In China, which is still a developing country and has a large income gap, affordability is a factor that cannot be ignored; 3, IVF/ICSI technology is more disruptive to female physiology. Nevertheless, like assisted reproductive technologies (such as IVF), this method still has a certain failure rate, and not all obstructive azoospermia can be treated with microsurgical techniques. Sometimes, when performing a surgical procedure painstakingly, one cannot predict whether the seeds of success or failure will be planted, especially when faced with the expectations and full trust of the patient couple, one often feels a sense of pressure and responsibility, and the joy of success and the frustration of failure are often intertwined. But in any case, the use of microsurgery offers a practical option for couples who desire to try natural fertility, or who have limited financial means, as well as an important means for male surgeons to treat this type of disease. Some statistics show that the success rate is about (i.e. sperms are found in the semen) 80% or more, and the conception rate is about 35%, which actually depends very much on the condition of the patient’s epididymal fluid, if there is more outflow and more sperms, the patient rarely fails, on the contrary, if there is little outflow after the epididymal duct is incised during the operation, and sperms are rare or only seen, the success rate of the operation is lower. Due to long-term obstruction, or antibodies and other reasons, most patients show weak or dead sperm in the early post-operative examination, but most of them will gradually get better as the genital tract is open, of course, the process will generally be faster with some medication-assisted at this time. Some doctors who do not perform microsurgery are wrong to rush their patients to IVF because they do not understand this phenomenon. Of course, the assessment of when to try to conceive naturally and when to receive assisted reproduction is complex, involving the age of the woman, treatment course, etc., and careful evaluation is recommended.