In the realm of pediatric urology, varicocele stands as a common yet contentious issue due to its possible impact on future fertility. The crucial points of contention involve the difficulties in detecting at-risk children early on, determining the best time for intervention, and selecting the most suitable treatment methods. This extensive review consolidates current insights on how varicocele in adolescents can lead to infertility, delving into alternative indicators like testicular size, sperm quality, and hormone levels in the blood. In addition, we explore the various approaches to evaluating and treating this condition from a holistic perspective, aiming to enhance patient care and outcomes.