Abstract: Objective To discuss the optimal clinical therapy of distal tubal obstructive infertility by comparing the natural pregnancy rate after conservative and reconstructive laparoscopic operations of mild, moderate and severe distal tubal obstructive infertility. Methods Clinical data of 245 patients with distal tubal obstructive infertility who underwent laparoscopic surgery from January 2005 to October 2010 were retrospectively analyzed, and their intrauterine pregnancy rate and ectopic pregnancy rate were compared. All patients were divided into three groups according to the degree of tubal obstruction and were followed up for more than 2 years after operation. Results The intrauterine pregnancy rate and ectopic pregnancy rate of 245 patients with distal tubal obstructive infertility after laparoscopic surgery in preserving reproductive tubal function was 26.5% (65/245) and 4.1% (10/245), respectively. According to tubal obstruction, the intrauterine pregnancy rate was 40.9% (mild), 31.1% (moderate), 11.4% (severe), respectively. There was no statistical signifcance compared with mild and moderate cases (P> 0.05) while the clinical pregnancy rate of severe tubal disease was signifcantly lower than that of mild to moderate cases (P< 0.05). Conclusion Laparoscopic surgery is an effective method for distal tubal obstruction. The optimal treatment for patients with mild to moderate distal tubal obstruction is adhesions lyses and tubal reconstruction striving for natural pregnancy. However, the severe distal tubal occlusion should undergo in vitro fertilization-embryo transfer (IVF-ET) after tubal ligation or salpingectomy.