Some men can feel a mass of cords in the scrotum, which some people describe as “worm-like”, “caviar-like” and other cystic compressible objects, and in severe cases, they can directly “see” them. The scrotum is full and swollen and can also be detected by ultrasound, which is clinically diagnosed as varicocele, a common disease in men that occurs mostly on the left side and can occur at any age, with an incidence of about 15% in the general population. People have known about varicocele for quite a long time, but recent technological advances have revolutionized the treatment of the disease and many deep-rooted traditional beliefs have changed significantly. In varicocele, when standing, the scrotum is distended with a feeling of heaviness and swelling, and even painful discomfort, which may radiate to the lower abdomen, groin or thighs, and is aggravated when standing and walking, and relieved after lying down and resting. Clinical symptoms and the degree of varicocele can be inconsistent; some patients with very severe varicocele can have no symptoms, while others with mild varicocele can have more severe cramping pain and even neurological symptoms such as insomnia, loss of appetite and dizziness. Since varicocele can have a significant adverse effect on the testes, it can cause abnormal semen quality in men, and studies have found that up to 54.8% of men with varicocele have abnormal semen quality, which affects male fertility. The incidence of varicocele in male infertility reaches 39%, while in secondary infertility the incidence is as high as 60% to 70%. Surgery is the only effective treatment for varicocele Surgery is recognized as the only effective treatment for varicocele, which can eliminate the local swelling and painful discomfort brought about by the disease and improve the quality of semen. Some physicians often base their determination of treatment for people with varicocele and their choice of treatment on personal knowledge and clinical experience, but in practice, the choice of surgical treatment should still follow certain principles and should be kept up to date. The main indications for surgical treatment include: varicocele causing significant pain and discomfort on the affected side, which the patient cannot tolerate; varicocele causing testicular spermatogenic dysfunction and progressive decrease in semen quality, which affects male fertility. Common surgical methods include: open surgery, laparoscopic surgery and embolization and sclerotherapy. Open surgery includes, trans-inguinal, inguinal and retroperitoneal ligation of the internal spermatic vein, a classic method that has been widely performed in clinical practice for many years. Laparoscopic surgery is a minimally invasive method developed in recent years, which does not require an incision, but only 3 small holes in the abdomen and operation, observed on a TV monitor, to complete the procedure, with a lower rate of treatment failure and a shorter operative and hospital stay, especially for those with bilateral varicocele. Embolization sclerotherapy can be performed under local anesthesia and eliminates the need for open surgery, but embolization failure or recurrence is more common and is rarely used today. (1) The absence of children may not always be due to varicocele. Since many varicocele patients can also have children normally, having varicocele does not always affect fertility. The key to fertility in varicocele patients is the degree of damage to the testicles, which can be determined by a simple testicular examination and semen analysis. For those who are infertile combined with varicocele, if the semen examination results are normal, surgery can be temporarily disregarded and regular semen routine examination can be performed every 3 to 6 months. As long as there is no significant change in semen quality, it can be kept under observation and attention can be paid to finding other factors of infertility, especially the evaluation of the wife’s fertility. For those male infertility patients with varicocele and abnormal semen quality, varicocele may not be the only or main cause of infertility, but the patient may also have a combination of other diseases or abnormalities that affect fertility. Only those who have not found other obvious abnormalities, but the deterioration of semen quality and varicocele are progressively aggravated together, are highly suspected that varicocele is affecting male fertility, and the active intervention at this time is more likely to obtain more satisfactory results. (2) Timing of surgery and outcome of treatment in infertile patients The surgery of infertile patients with varicocele should be considered in the following cases: the testicle on the affected side of varicocele is significantly smaller and softer compared to the opposite testicle; the semen quality is abnormal, especially if the semen quality is deteriorating after several consecutive examinations at regular intervals (every 2 to 3 months). In general, within 1 to 2 years after surgery, the improvement of semen routine examination can reach 50% to 70%, and 30% to 40% of the patients can make their wives pregnant naturally, and the improvement rate of semen and the natural pregnancy rate of their wives can be improved with appropriate medication after surgery. However, some of the surgically treated varicocele patients still do not have children after several years, the possible reasons are: the timing of surgery is too late, after all, varicocele is a progressive aggravating disease and can cause damage to the testicles that is difficult to recover; at the same time, there are other factors affecting fertility that are not removed; the wife has factors that affect fertility; there are factors that modern medicine has not yet recognized potential factors affecting fertility. Therefore, each case should be analyzed and treated differently. For example, a comprehensive fertility assessment must be conducted before choosing surgical treatment, so as to lay the foundation for the subsequent selection of medication and treatment; the spouse should be examined and treated at the same time, so as not to make it difficult for the man to have a chance to have children even if his fertility has gradually improved and returned to normal after recovery from surgery; for those with more serious conditions, such as obvious testicular atrophy and a particularly low sperm count (or even occasional sperm) For those with more serious conditions, such as testicular atrophy and a particularly low sperm count (or even occasional sperm), even if surgery is chosen, the prognosis is not too good and it is difficult to return to natural fertility, so surgery at this time may not be beneficial to the patient. （In fact, the goal of many infertile men in treating varicocele is to have a child. For those who choose surgery for varicocele with little possibility of regaining natural fertility, especially those who are older and need to solve their fertility problems as soon as possible, it should not be too difficult to choose laboratory technology to solve their fertility problems. Modern fertility technology can solve the problem as long as there is a sperm, and most of even severely infertile men can realize their desire to become parents. The current IVF technology has become a routine technology in many large hospitals, and the success rate of treatment is steadily increasing, and the success rate in China has reached 30-40%, combined with new technologies such as embryo freezing, which makes the success rate of each treatment cycle even more improved. Moreover, if the treatment is unsuccessful once, it can be performed again, and sooner or later, the infertile couples will be able to fulfill their dreams.