〔Abstract〕 Objective To investigate the effect of modified single-needle ligation of interspermatic vas to epididymis (LIVE) under the microscope on patients with obstructive azoospermia (OA). Methods A total of 91 OA patients admitted to the First Affiliated Hospital of Zhengzhou University from October 2019 to May 2023 were selected as the subjects of this study. Among them, 45 patients with improved single-needle LIVE under the microscope were set into the modified single-needle group, and 46 patients with double-needle LIVE under the microscope were set into the double-needle group. The operation, hospital stay, relapse rate, total forward sperm motility, sperm concentration, total sperm motility level and spouse pregnancy results were compared between the two groups. Results Compared with the double-needle group, the operation time of the improved single acupuncture group was longer, and the difference was statistically significant (P < 0.05). There was no significant difference in the length of hospitalization between the two groups (P > 0.05). Three months after surgery, the recurrence rate was 68.88% in the modified single-needle group and 71.73% in the double-needle group, and there was no statistical significance between groups (P > 0.05). Compared with 3 months after surgery, the total forward motility, sperm concentration and total motility level of the two groups were increased at 6 months after surgery, and the differences were statistically significant (P < 0.05). There was no significant difference in total forward motility, sperm concentration and total motility level between the two groups at 3 and 6 months after operation (P > 0.05). After 6 months of follow-up, the spouse pregnancy rate was 35.55% in the modified single-needle group and 39.13% in the double-needle group, and there was no statistical significance between groups (P > 0.05). Conclusion Modified single-needle LIVE under the microscope has the same efficacy as double-needle LIVE in the treatment of OA patients. Compared with double-needle LIVE, single-needle LIVE has a slightly longer operation time, but it is easier to operate and easier to obtain surgical materials, so it is easier to be popularized.