In cases of infertility with varicocele, surgery should be considered in the following cases: the testicle on the affected side of the varicocele is significantly smaller and softer compared to the opposite testicle; the semen quality is abnormal, especially if the semen quality deteriorates after regular (every 2 to 3 months) consecutive examinations. In general, within 1 to 2 years after the surgery, the improvement of the patient’s semen routine examination can reach 50% to 70%, and those who can make their wives pregnant naturally account for 30% to 40%, and the improvement rate of semen and the natural pregnancy rate of their wives can be improved with appropriate medication after the surgery. However, some of those who have undergone surgery for varicocele still do not have children after several years, and the possible reasons are. The timing of surgery is chosen too late, after all, varicocele is a progressive aggravating disease and can cause damage to the testicles that is difficult to recover, and there are other factors that affect fertility, factors that affect fertility in the wife, and potential factors that have not been recognized by modern medicine that affect fertility. Therefore, each of the many cases should be analyzed and treated differently. Before choosing surgical treatment, a comprehensive fertility assessment must be carried out to lay the foundation for the subsequent selection of drugs to match the treatment; the spouse should be examined and treated at the same time to avoid difficulties in having a chance to have children even if the man’s fertility has been gradually improving and returning to normal after recovering from surgery; for those with more serious conditions, such as those with significantly shrunken testicles and a particularly low sperm count (or even occasional sperm). The prognosis is not too good, even if surgery is chosen, and it is difficult to return to natural fertility, so surgery at this time may not be beneficial to the patient.