Microsurgical techniques are often used for reconstruction of the male genital tract in order to restore fertility. Advances in technology have led to improved outcomes for patients and men previously felt to be incapable of fathering children are now biologic parents. Use of the operating microscope has led to improved outcomes in vasectomy reversal and has made possible the connection of the vas deferens to a single delicate epididymal tubule. In addition to advances in the area of magnification, novel techniques such as robotic assisted surgery or use of biologic sealants hold promise for further refinement. New surgical techniques and high power magnification has enabled surgeons to find isolated areas of sperm production in testicles of patients that previously were felt to make no sperm at all. In this article we will review the indications, outcomes, and technological advances in the various microsurgical procedures to treat male infertility are.