OBJECTIVE To compare the outcomes of two approaches (inguinal and subinguinal) of microsurgical varicocelectomy (MV) in Chinese infertile men. METHODS 120 infertile men who met the inclusion criteria were randomly assigned to two groups and operated with MV using different approaches. The outcomes and complications were then compared. RESULTS The two groups were similar in all aspects except the percentage of patients using analgesic at 27 h postoperatively (57.6% in the inguinal group, 37.5% in the subinguinal group; p < 0.05). Spontaneous pregnancy was achieved at a ratio of 33.9% in the inguinal group and 30.4% in subinguinal group. The median values of semen parameters were significantly improved postoperatively in both groups. CONCLUSIONS Both approaches are effective methods in the repair of varicocele in infertile men, but more analgesic medication at the first day after operation may be required in inguinal group.