The earliest prototypes began in 1903 and were in fact simply “anastomoses” between multiple incised epididymal ducts and an open vas deferens lumen to create a fistula. The first true anastomosis of the vas deferens and epididymal ducts was performed by Lespinasse in 1918, which was a non-microsurgical procedure with very poor results. In 1978, Silber performed the first microsurgical end-to-end anastomosis of a single epididymal duct and vas deferens. In 1980, Wagenknecht applied microsurgical techniques to attempt the end-lateral anastomosis of the vas deferens epididymal duct. The application of microsurgery increased the postoperative recanalization rate to 50-80% and the conception rate to 11-56%. In 1997 Berger used a new microsurgical anastomosis technique —- triangular triple stitch overlapping vas deferens epididymal anastomosis with a 92% recanalization rate and reduced complications. In 2000 Marmar modified it to a transverse two-stitch overlapping anastomosis. In 2001, Cornell Goldstein’s group further improved the technique to longitudinal two-stitch vasectomy epididymal anastomosis, and the recanalization rate and complications were better than the previous one. The technique was evaluated as a major technical breakthrough in the 25 years since the first microsurgical vasectomy epididymal anastomosis was performed in 1978, and has now become the technique of choice for vasectomy epididymal anastomosis in North America and Europe. Advantages of microsurgical vasectomy compared with IVF/ICSI 1. offspring can be obtained through natural conception; 2. cost effective, i.e. low cost per offspring obtained; 3. IVF/ICSI technique is more disruptive to female physiology.