Among male infertility patients, azoospermia patients account for about 10-15%, and obstructive azoospermia accounts for 40% of azoospermia. Most hospitals recommend IVF for the treatment of obstructive azoospermia, but the cost of IVF is very expensive and the success rate is about 30-40%, so a considerable part of the population can hardly afford such a huge financial pressure. It is not known that there are a number of obstructive azoospermia that can be treated by surgical procedures. With skilled technique, the success rate of this surgery is high. Under normal circumstances, sperm produced by the testes are discharged into the urethra through the epididymis, vas deferens, seminal vesicles, and ejaculatory ducts during ejaculation. Infection, congenital abnormalities, trauma, etc. can all cause epididymal obstruction and lead to male infertility. However, not all patients with obstructive azoospermia are suitable for surgical treatment. Therefore, patients need to be examined before surgery, focusing on the vas deferens, epididymis, and testes; patients with vas deferens, small testes, and epididymal dysplasia are not suitable for such surgery. Only patients with lesions in the epididymis or lesions in the vas deferens of the scrotal segment may benefit from this type of surgery. Surgical steps: 1. Incision selection: Since the surgery addresses the vas deferens or epididymal lesions in the scrotal segment, the surgical incision is selected in the scrotum, either a transverse or longitudinal incision of the scrotum can be made, with a length of about 5 cm. 2. Check the patency of the vas deferens: free the vas deferens about 4 cm from the end near the epididymis, paying attention to protect the supply vessels of the vas deferens. Use a fine trocar needle or partially incise the lumen of the vas deferens and push saline into the seminal vesicle end of the vas deferens to perform a fluid passage test. When the pushing is smooth and there is no obvious resistance, the seminal vesicle end of the vas deferens is considered to be patent and the next step can be performed. If there is a lot of resistance during the lavage test, or if it is impossible to push the injection at all, it is considered that there may be obstruction at a certain location of the vas deferens. 3.Check the condition of the epididymis: Under normal circumstances the epididymal duct is very fine, and when there is obstruction the upstream epididymal duct at the site of obstruction will be dilated due to the accumulation of semen, but it is almost indistinguishable to the naked eye, so it is necessary to use an operating microscope and magnify the epididymal duct 16 times to 25 times to perform the operation. An incision of approximately 3 mm is made in the epididymis to find a fuller epididymal duct. Using a 10-0 nylon thread with a double-ended needle, a stitch is left in the wall of the epididymis and the epididymal duct is incised between the two stitches and a small amount of epididymal fluid is aspirated to check for sperm. If sperm are found to prove that the epididymis above here is open, a vas deferens epididymal anastomosis can be performed so that the sperm can bypass the obstruction. 4. When the vas deferens is open and sperm are found in the epididymis, a vas deferens epididymal anastomosis can be performed. A double-headed needle is sewn through the wall of the vas deferens separately and then knotted separately, and the incision of the epididymal duct can be snapped into the lumen of the vas deferens. The epididymal peritoneum is sutured to the vas deferens peritoneum and the anastomosis is encapsulated. 5.The testis is returned to the scrotum and the incision is sutured layer by layer. 6.After surgery, patients are advised to rest in bed and reduce activities to prevent anastomotic complications. Sexual intercourse is forbidden for 1 month after surgery, and no sperm discharge is allowed to prevent anastomotic fistula; after 1 month, sexual intercourse can be performed appropriately, but not too frequently, and then gradually return to normal. Since it takes time for the spermatogenic function of the testes to recover, patients are advised to review the semen routine after 3 months of surgery. If sperm appear in the semen, it indicates successful recanalization and continue to follow up until the patient’s spouse becomes pregnant. If no sperm is seen in the semen routine within 1 year, the recanalization is a failure and the patient is advised to choose assisted reproduction. With the improvement of microscopic surgery technology, the surgical recanalization rate has gradually increased, and the reported recanalization rate after surgery can reach about 60%-80%, and the pregnancy rate after recanalization can reach 30%-40%. Men undergoing this procedure receive only one surgical trauma, while IVF men may need multiple traumas for sperm retrieval; spouses do not need to receive hormonal drugs; and both spouses conceive naturally, without the genetic risks that may arise from human intervention. Therefore, it is another useful option for patients with obstructive azoospermia, and even if the sperm tract does not reopen after the procedure for various reasons, it does not affect assisted reproduction in the future.