It has been reported that nearly 10-15% of married couples are unable to have children naturally, and the proportion is on the rise, with male infertility accounting for 50% of the cases. In the past, the treatment of male infertility was mostly limited to medication, and there were numerous prescriptions, but few of them had a clear effect. With the advent of assisted reproductive technology (ART), patients have no choice but to choose ART to have offspring when medication is ineffective. For a long time, there was not much progress in the treatment of male infertility until the early twentieth century, when microsurgery technology was systematically introduced into China by Prof. Li Shihua of Cornell University in the United States, and Chinese male surgeons actively carried out microsurgery for male infertility, which led to a revolutionary change in the treatment options for male infertility. Microsurgery is the treatment of the cause of male infertility in order to achieve natural or assisted conception, which is different from assisted reproduction techniques, where conception is achieved through artificial techniques that facilitate the union of sperm and egg. Microsurgery can treat 2 major causes of male infertility: (1) disorders of spermatogenesis, such as microscopic spermatozoa ligation and testicular microsperm extraction; and (2) obstruction of the vas deferens, such as microscopic vasovasostomy and microscopic vasovaso-epidididympanic anastomosis. Since the vas deferens is very thin and cannot be clearly recognized by the naked eye, only with the help of a surgical microscope can fine surgical operations be realized and good surgical results be achieved. More than 70% of male infertility factors can be treated by microsurgery. Microsurgery is very delicate and any improper operation may affect the surgical result, therefore, microsurgeons need to undergo strict and standardized theoretical and surgical training. Varicocele is one of the most common causes of male infertility and affects the quality of male semen leading to infertility. The prevalence of varicocele is 15% in the general male population and higher in the infertile population, accounting for about 40% of primary infertility and 70% of secondary infertility. It is a condition that can be corrected by surgical treatment. Urologists usually use high ligation or laparoscopic ligation, which can also achieve some results, but postoperative complications are common, such as testicular syringomyelia and postoperative recurrence. In contrast, microscopic spermatic vein ligation can preserve the testicular artery and lymphatic vessels and completely ligate the vein, so there are very few postoperative complications, but the results are the best. Microscopic spermatic vein ligation has been called the “gold standard” procedure for varicocele. Improvement in semen quality after the procedure has been reported to be about 60%-80%, and pregnancy rates for couples have been reported to be about 30%-60%. After the surgery, it is required to avoid strenuous exercise for a short period of time, and generally need to be observed for at least six months, and the semen quality should be rechecked on a regular basis. Vas deferens obstruction is one of the common causes of male azoospermia, accounting for about 40% of azoospermia. Some of these vas deferens obstruction and epididymal obstruction can be treated by microsurgery. Vasectomy is the most common cause of vasectomy obstruction. Vasectomy is a commonly used form of male sterilization in Western countries, while it is less common in China. In China, epididymal obstruction is the most common cause of obstruction and may be related to reproductive tract infections. Most urologists lack a clear understanding of epididymal obstruction, which is usually diagnosed with the help of physical examination of the reproductive system and ultrasonography. Microscopic vasovaso-epididympanic anastomosis is an effective means of treating epididymal obstruction and is the most technically advanced procedure in microsurgery for male infertility. The inner diameter of the human vas deferens is about 300 μm, and the inner diameter of the epididymal ducts is about 150 μm, and the diameter of the suture used is less than 15 μm, which is about 1/4 of a hair strand and 1/10-1/20 of a fingerprint; therefore, without the help of a surgical microscope, which enlarges the field of view to a certain number of times, it is not possible to realize such a delicate surgery. It has been reported that through microscopic vasovaso-epididymitis anastomosis, sperms can be detected again in the semen of 50%-90% of azoospermic patients, and the pregnancy rate of spouses reaches 20-40%. After the operation, patients are required to prohibit sexual intercourse for 1 month and avoid strenuous exercise for 3 months. Follow-up is usually 1-2 years. If the procedure is unsuccessful consider IVF. Non-obstructive azoospermia is the most difficult to treat in male infertility, accounting for about 60% of azoospermia, which is usually due to testicular spermatogenesis dysfunction due to various reasons, such as congenital causes, mumps, cryptorchidism, and post-tumor radiotherapy. It is difficult to restore the spermatogenic function of testis by drug treatment. In the past, for this kind of patients, the only way is to use sperm bank’s donor fertilization or adoption. at the end of 1990s, foreign scholars with the help of surgical microscope, found that this kind of patients’ testicles contain sperms in the localized varicocele, which were separated and used for IVF with success. Since then, this technique has been widely promoted in fertility centers, and 40-60% of patients with non-obstructive azoospermia have obtained sperm through this procedure, thus obtaining biological children. Pre-operative patients need to be thoroughly evaluated for genetic problems, such as chromosomes and Y chromosomes, to detect possible genetic disorders. Genetically pro-life offspring can be obtained in some patients through this procedure. Microsurgery allows some patients with male infertility to be effectively treated and even achieve natural conception. Microsurgery allows patients to avoid the financial burden and possible physiologic effects on the female partner associated with assisted reproductive technology. However, microsurgery needs to be combined with assisted reproduction techniques, and in order to achieve good surgical results, suitable patients need to be selected and surgeons need to undergo rigorous and standardized training.