The aim of this study was to compare outcomes of microsurgical varicocelectomy (MV) versus percutaneous angioembolization (AE) in men with varicoceles causing infertility or scrotal pain. Endpoints included postoperative changes in semen parameters, complication rates, pain relief, need for additional interventions, and the influence of body mass index (BMI). We retrospectively reviewed 264 male patients treated for varicocele from July 2015 to July 2024 (MV: 214 patients, and AE: 50 patients). Only patients older than 18 years were included. Indications were infertility or chronic varicocele-related scrotal pain. Pre- and post-treatment semen analyses were compared in infertile men, and pain outcomes were assessed in those treated for pain. Complications and secondary interventions were recorded, and outcomes were stratified by BMI. MV significantly improved sperm concentration, motility, and total motile count within 3–6 months, while AE showed no significant change. Complications occurred only in the MV group (8.9%), including hydrocele, hematoma, and surgical site infection, while no complications were reported in the AE group. Persistent pain was observed in one-third of patients in both groups, and AE was associated with a higher rate of secondary intervention (14.0%) compared to MV (6.6%). BMI was not linked to complications or operative time but was associated with poorer baseline semen quality. Within 3–6 months post-treatment, varicocelectomy yielded greater improvement in semen quality, while AE offered a favorable safety profile but less reproductive benefit and a higher retreatment rate. Both approaches were safe across BMI categories, though longer-term studies are needed to clarify patient selection and delayed outcomes.

Keywords: angioembolization; infertility; obesity; varicocele; varicocelectomy