Abstract Background: Anogenital distance is a marker of genital development and adult testicular function. It is currently difficult to assess which patients are most likely to benefit from varicocelectomy. The present study showed that men with a longer AGD had a higher likelihood of improvement after varicocelectomy. Aim of Study: Is to evaluate the role of Anogenital Distance (AGD) measurement in the prediction of the efficacy of varicocelectomy on the improvement of semen parameters in primary male infertility. Material and Methods: •A prospective study included sixty male patients presented with primary infertility and clinical evident primary varic-ocele with altered semen parameters. •All patients underwent measuring the distance from the posterior aspect of the scrotum to the anal verge in millimeters using a digital caliper. •All patients underwent varicocelectomy (subinguinal ap-proach) by the same experienced surgeon using intraoperative Doppler and magnification loupe. •All patients were followed-up with semen analysis after 6 months of varicocele repair. Results: •Overall, 76.7% of our patients (46 patients) revealed improvement in their semen parameters after 6 months of varicocelectomy, men with longer AGD had better improve-ment in their semen parameters after surgery than men with shorter AGD, 30 patients (88.2%) with AGD >!30mm vs. 16 patients (61.5%) with AGD <30mm. •In patients with AGD >30mm. The sperm concentration increased from 13.5 to 18.8 million sperm per ml (p-value <0.001), the progressive motility (A + B) increased from 27.9% to 39.5% (p-value <0.001), the mean abnormal forms decreased from 57.2% to 36.2% (p-value <0.001). While in the other group with AGD <30mm there was no statistical differences in different semen parameters post-operatively. Conclusions: AGD may provide a novel metric to assess intrinsic testicular function and predict efficacy of varicocele repair.