Varicocele is a common finding in approximately 20% of adolescents and adult men and in about 40% of infertile patients. Although numerous theories addressing the deteriorating impact on the testis are known, the direct connection between varicocele and infertility is not clear. It is well known that after operative therapies an improvement in sperm quality is found. However, the impact on pregnancy in an infertile coupleship is controversial. While the most recent meta-analysis found an increased pregnancy rate after therapy, the Cochrane Reviews with the last update in 2009 did not. In summary, operative therapy seems justified in selected patients with infertility.