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1 Introduction Varicocele, defined as the abnormal dilatation and tortuosity of the pampiniform venous plexus within the spermatic cord, is recognized as one of the most prevalent causes of male infertility ( Current evidence suggests that varicocele is not merely a benign vascular anomaly but rather a complex pathological condition involving multifactorial disruptions in the testicular microenvironment ( This review aims to elucidate the underlying mechanisms by which varicocele disrupts the testicular microenvironment, with particular emphasis on anatomical and hemodynamic abnormalities, altered testicular perfusion and oxygenation, and their downstream effects on spermatogenesis

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