This study was done to compare microsurgical subinguinal varicocelectomy with laparoscopic and inguinal 
varicocelectomy as regards the technique and the impact on pregnancy rates. The study comprised 161 patients complaining of infertility with no proven female factor as a cause of infertility. The patients were randomly assigned into 3 treatment groups. Twenty three patients were excluded due to lack of follow up data and the remaining 138 patients were arranged in 3 groups according to the technique used for varicocelectomy. Group I consisted of 48 patients treated by conventional inguinal technique. Group II consisted of 43 patients managed by laparoscopic transperitoneal technique, and group III included 47 patients who underwent microsurgical subinguinal varicocelectomy. Fifteen cases were recurrent after previous surgery, 5 in inguinal group and 10 in microsurgical group. The patients were followed up with clinical and color duplex 6 and 12 months after treatment to exclude possibility of recurrence or hydrocele formation. Semen analysis was carried out before treatment and repeated 6, 9 and 12 months after treatment and follow up for possible pregnancy was extended for two years after surgery. The mean operative time was significantly shorter among patients treated with microsurgical technique compared to group I or group II. For microsurgical group, the hospital stay (<24 hours) and period of convalescence (3±1 days) were nearly similar to laparoscopic group and significantly shorter than inguinal group. The recurrence rate was significantly higher among laparoscopic group (18.6%) compared to inguinal (4.16%) and microsurgical technique (no detected recurrence). The incidence of hydrocoele formation was the highest among inguinal varicocelectomy technique (20.8%) compared to laparoscopic (11.6%) and microsurgical technique (0%). Pregnancy rate was significantly higher among microsurgical 
varicocelectomy group (59.57%) compared to inguinal varicocelectomy (31.25%) and laparoscopic varicocelectomy (32.55%). 
Microsurgical subinguinal varicocelectomy was proved to be the most optimal varicocelectomy with no hydrocele or 
recurrence and with the highest pregnancy rate. So, we recommend microsurgical varicocelectomy as the treatment of choice for varicocele including recurrent cases.