Microsurgical varicocelectomy (MVC) is the current gold standard for the treatment of varicocele. Studies have shown that MVC can bring certain clinical benefits to patients with varicocele and male infertility. In today’s era of assisted reproduction, MVC is clinical used usually to improve ART outcomes before treatment with assisted reproductive technology (ART). This article summarizes the efficacy evaluation and cost-effectiveness of MVC combined with ART. Although there is a lack of prospective evidence supporting MVC before ART, many large retrospective studies have shown that operating MVC before using ART may improve ART outcomes. However, large-scale and standardized clinical trials are still needed to further verify the effectiveness and feasibility of MVC before ART.