Varicocele is a dilatation, thickening and tortuosity of the trapezius plexus in the spermatic cord, mostly seen in young adults, with an incidence of about 15% in the general population and 78% to 93% on the left side. The prevalence of subclinical varicocele based on ultrasound or spermatic venography remains unclear due to the lack of a unified “gold standard”. For those men with varicocele and abnormal semen quality, varicocele may not be the sole or primary cause of infertility, but may be combined with other diseases or abnormalities that affect fertility. Only in those cases where no other significant abnormality is found, but semen quality and varicocele deteriorate progressively in tandem, is there a high suspicion that varicocele is affecting male fertility. 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 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 in those cases where no other significant abnormality is found, but the deterioration of semen quality and varicocele is progressively aggravated, is there a high suspicion that varicocele is affecting male fertility, and active intervention at this time is more likely to achieve a more satisfactory outcome.