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This chapter focuses on the salient features of ductal obstruction of the male genital tract to allow the identification of the appropriate candidates for microsurgical treatment. It examines the role of microsurgical reconstruction in the era of assisted reproductive technology. Vasovasostomy may be performed using optical loupes or an operative microscope. Macrosurgical techniques suffer from higher rates of failure and are now of a historic nature. Two of the most widely accepted techniques, the modified one-layer and the multilayer vasal anastomosis, are described in this chapter. Special approaches for reconstruction are indicated when the vasal obstruction is outside of the scrotum. When sperm were absent from the intraoperative vasal fluid, patency and pregnancy results correlated with characteristics of vasal fluid with copious clear fluid portending the best outcomes. The absence of fluid or a thick, inspissated fluid suggests an epididymal obstruction, and a vasoepididymostomy should be considered.