Varicoceles are present in about 15% of males. In spite of substantial research, uncertainty remains about etiology, pathophysiology and treatment modalities. Furthermore, there is no consensus about the possible association between varicoceles and male infertility. The purpose of this review is to shed light on these aspects. A review of the literature suggests an association between varicoceles and infertility. The pathophysiology seems to be multifactorial. Microsurgical varicocelectomy seems to be the treatment with the lowest number of complications and recurrences.