Varicocele is the most common cause of male infertility (click here to learn what varicocele is). But do varicose sperm veins always need surgery when they are found? The following principles should be followed: 1. varicose spermatic veins are varicose and are they serious? Generally bilateral VC is a more serious case; 2. whether the sperm density and sperm vitality are low; 3. whether the left testicle is smaller and atrophied than the right testicle. If all of the above points are met, then VC surgery needs to be considered. Updated July 24, 2020 The patient was severely oligospermic before surgery, and testing revealed bilateral varicocele, which required only the left spermatic varicocele surgery depending on the severity. The patient did not hesitate to schedule the surgery immediately and 1 month postoperatively, doubled… 2 months after surgery, doubled… Today, 3 months after surgery, it is completely normal. It’s not even 4 months post-op when the ultrasound needs to be reviewed …… Another case: Before treatment, the sperm density of this patient was only 2-3 million/ml, which is extremely severe oligozoospermia. Ultrasound showed left spermatic varicose vein with 3.3 mm internal diameter and reflux time > 6s, which was severe spermatic varicose vein. Microsurgical internal spermatic vein ligation was performed in August 2019. After surgery, for some reason (work, epidemic, etc.) irregular medication was used, and eight months after surgery, semen indicators improved significantly. One month of regular medication, semen parameters completely returned to normal. The sperm density increased from 2-3 million/ml to 20 million/ml, a 10-fold increase. The effect was great, from only being able to do second generation in vitro (ICSI) to natural pregnancy without difficulty. The biggest danger of varicocele is that it affects the spermatogenic function of the testes, which already produces discomfort and can furthermore lead to a decrease in the androgen-producing function of the testes. For infertility patients with poor semen quality, they need to undergo surgery as soon as possible after excluding other factors that cause infertility. The patient in this paper fits this profile, and the semen quality improved after the surgery was performed, and the postoperative report shows that the sperm density of this patient was 40.844×106/ml, with 63.82% of class a sperm and a+b=75.61%, far exceeding the WHO Laboratory Test Manual for Human Semen (5th edition) index (sperm density 15×106/ml; a+b≥40% ). Currently, the treatment of varicocele is mainly surgical, but surgical treatment does not improve the semen quality of patients 100%. According to the results of our study, semen quality improved in 60% to 70% of patients after surgery. The fact that semen quality did not improve in some patients after surgery suggests that these patients may have factors that are currently difficult to detect that are continuously affecting testicular spermatogenesis. If the vein is missed intraoperatively or recurs postoperatively, the chance of recurrence is 1%, which can also to lead to no improvement in semen quality. Overall, treatment of varicocele improves semen parameters, fertility, and the risk of treatment is low.