To define the causes of obstructive azoospermia (OA) and evaluate the possibility and efficacy of microsurgical correction.

Sixty-seven patients diagnosed as OA with normal spermatogenesis preoperatively and initially planned to microsurgical vasoepididymostomy from December 2003 and November 2009 were retrospectively analyzed. Causes of OA were analyzed and patency rate and pregnancy outcomes of their female partners were measured.

Thirty-one patients (46.3%) could not correct their OA because of obstruction of the distal vas deferens, epididymal atrophy and/or hypotrophy and vasal injury due to previous surgery. Among the 36 patients undergone microsurgical vasoepididymostomy (mean age of patients and their female partners were 32.9 and 31.3 years, respectively), 32 patients (88.9%) were corrected bilaterally and 4 patients (11.1%) unilaterally. The overall patency rate was 17 patients (47.2%); being 15 and 2 patients for bilateral and unilateral procedure, respectively. Among the 17 patients regained the patency after surgery, except 3 cases without followed up, 6 cases achieved natural pregnancy and also 6 cases achieved the pregnancy using the assisted reproduction.

According to the affected point of reproductive tract, not all men with obstructive azoospermia were candidates for microsurgical reconstruction. However, reasonable outcomes were achieved in the microsurgical reconstruction cases and it should be primary therapeutic method in obstructive azoospermia. For those in whom reconstruction is not a viable option, surgical methods for sperm retrieval are available to have their own biological children.