Objective · To investigate the strategy of microsurgical treatment to obstructive azoospermia (OA). Methods · There were totally 182 OA patients received surgical treatments. Various patients were preformed various microsurgical treatment. Results · Among the 182 patients, 86 patients had epididymal obstruction. Other etiologies included vasal obstruction in 30 cases, congenital bilateral absence of vas deferens in 48 cases, ejaculatory duct obstruction in 17 cases, obstruction of rete testis in 1 case. 114 patients were performed microsurgery, 92 cases were followed up. The mean follow-up period was 9 months (3-16 months). The patent rate was 71.7% (66/92), the natural pregnant rate was 32.6% (29/89). Conclusion · For the obstructive azoospermia, the etiology and the obstructive site is multiform, microsurgery is the first choice, various patients can be preformed various treatment. The microsurgery techniques in OA treatments have an obvious advantage, especially for the chance for achieving natural pregnancy.