The aim of this study is to evaluate the beneifts of laparoscopic Doppler ultrasound (LDU) application during laparoscopic varicocelectomy (LV), and to compare the surgical outcomes and complications between LDU?assisted LV (LDU?LV) and conventional LV for infertile patients with varicoceles;147 infertile patients were randomly divided into two groups. Operative and postoperative parameters, semen parameters, and the pregnancy rate were compared. There were no differences in baseline demographics. The operative time was signiifcantly longer in LDU?LV group than LV group. The incidence of postoperative hydrocele was 1.4%(1/72) in LDU?LV group versus 10.7%(8/75) in LV group, which showed a signiifcant difference (P<0.05). However, other surgical outcomes, such as postoperative hospital stay, postoperative recurrence, and testicular atrophy, were similar between the two groups. Sperm concentration and sperm motility were signiifcantly increased in both groups at 3, 6, and 12 months after surgery (P<0.01), and they were higher in LDU?LV than LV group in 12 months after surgery (34.21 ± 6.36 vs 29.99 ± 6.04 for concentration, P<0.05;40.72 ± 8.12 vs 37.31 ± 6.12 for motility, P0.05). In conclusion, compared with LV, LDU?LV could safely and effectively ligate all spermatic veins and preserve spermatic arteries without leading to high varicocele recurrence and postoperative hydrocele. Given the beneifts that sperm counts as well as sperm motility favoring LDU?LV, we recommend that LDU should be routinely used as an effective tool to improve outcomes and safety of laparoscopic varicocelectomy.