Background <p>Varicocele is one of the most prevalent reasons of men infertility, yet there is no consensus on the management of subclinical Varicocele (SCV). The aim of this work was to compare microsurgical varicocelectomy and conservative management among individuals with SCV and impaired semen parameters.</p> Methods <p>This was a prospective randomized study that was carried out on 52 adult males with SCV and impaired semen parameters complaining of scrotal pain or infertility. Patients were randomized in two equal groups: Group A: microsurgical varicocelectomy group and Group B: conservative management group. Both groups were compared regarding semen parameters, spontaneous pregnancy rate and scrotal pain.</p> Results <p>Sperm count, and motility significantly enhanced in both group A and group B (<i>P</i> &lt; 0.05). Group A had a significantly greater sperm count than group B (<i>P</i> &lt; 0.05), while sperm motility was insignificantly different across the two groups. Pregnancy rate significantly improved in group A (<i>P</i> &lt; 0.05), while scrotal pain was insignificantly different among the two groups.</p> Conclusions <p>Microsurgical varicocelectomy is a promising therapeutic option for infertile men diagnosed with SCV with higher rate of natural pregnancy compared to conservative management. Given study limitations, these findings should be interpreted with caution. Larger, multi‑center trials are needed to confirm the observed benefits.</p>