Objective: Microsurgical reconstruction is recommended for obstructions in the vas deferens and epididymis.However, intracytoplasmic sperm injection (ICSI) is the preferred therapy and microsurgical vasoepididyostomy (MVE) may be neglected for patients with epididymal obstruction.Fertility outcomes from large sample are absent.In this study we aimed to investigate the pregnancy and live birth rates of MVE for 241 patients with epididymal obstruction and indentify the possible predictive factors.Methods: From January 2011 to December 2013, 241 male patients with obstructive azoospermia underwent MVE in our center.Semen was analyzed 3 months postoperatively.The patency, pregnancy and live birth rates were evaluated.The preoperative and intraoperative data were compared between patency and nonpatency groups to indentify the factors affecting the patency rate.Univariate and multivariate analyses with Cox regression models were performed to identify predictors of spontaneous pregnancy.Results: 198(82.2%) patients were followed up and their data analyzed.The mean age of men and female partners were 31.0±5.8 and 28.4±4.4 years, respectively.Sperm was present in the ejaculate of 151 patients (76.3%) at a mean of 3.8 months postoperatively.Patients with 2 sides of anastomosis and distant anastomosis had higher patency rates.81 patients (40.9%) reported spontaneous pregnancy and a total of 73 newborns were successfully delivered.The overall live birth rate was 34.8%.Univariate and multivariate analyses revealed male age, sperm concentration and forward motility were independent predictive factors for natural pregnancy.Conclusion: The success rate is related to side and location of anastomosis.The sperm concentration and forward motility may predict the natural pregnancy.Therefore, microsurgical reconstruction is an effective treatment and should be the first choice for epididymal obstruction.