Techniques for microsurgical reconstruction of obstructive azoospermia

About 10%–15% of infertile men present with azoospermia, and ductal obstruction is the cause in 40% of them. For about 25–30 years, microsurgical reconstruction was the only way to manage obstructive azoospermia, and several innovative techniques have been developed and implemented. Presently, assisted reproductive technologies (ART) are available for these men as an alternative to surgery. Clinicians who treat these men must be familiar with all of these options, and many of the ART techniques have been covered in other sections of this symposium. However, the present article focuses on vasovasostomies and vasoepididymostomies. The intent of this review is to critique these microsurgical procedures, and present some surgical “pearls” related to them.