Men with testicular failure (TF) often undergo an extensive microsurgical dissection of the testicles to identify sperm (TESE procedure). Frequently no sperm is found. Although a varicocelectomy results in improved spermatogenesis in some men with TF, the role of varicocelectomy in the setting of a failed TESE is unknown. We present a case of recovery of spermatogenesis after varicocelectomy in a man who had a previous failed TESE. This case demonstrates that patients with a failed TESE may gain some benefit from a varicocelectomy and that this procedure may be offered as an alternative to donor insemination or adoption.