A 23-year-old healthy man has been unable to father a child.
Varicocele and Infertility
The most likely condition that the 23-year-old man has is a varicocele. A varicocele is an abnormal enlargement of the veins in the scrotum, which can cause blood to pool and result in impaired sperm production and decreased sperm quality. This condition is common in men and occurs in about 15% of the general population and up to 40% of men with infertility. Varicoceles are most commonly found on the left side because of the anatomy of the left testicular vein, which drains into the renal vein at a perpendicular angle, increasing the pressure in the vein and predisposing it to dilation.
In this case, the physical examination finding of the “bag of worms” sensation in the left spermatic cord is indicative of a varicocele. The normal size of the testes and scrotum with no palpable masses rules out testicular torsion, spermatocele, and seminoma. Laboratory studies showing oligospermia are also consistent with a varicocele, as impaired sperm production is a common consequence of this condition.
Several studies have found an association between varicoceles and infertility, with the degree of impairment depending on the severity of the varicocele. Treatment options for varicoceles include observation, surgical repair, or minimally invasive procedures such as embolization. Treatment may improve sperm count and quality, but it is not a guarantee of pregnancy, and couples may still require additional fertility treatments.
In conclusion, a varicocele is the most likely condition for the 23-year-old man’s infertility, based on the physical examination findings of a bag of worms sensation in the left spermatic cord, oligospermia, and the absence of other physical abnormalities. Early diagnosis and treatment may improve the chances of successful conception, and further evaluation may be necessary to determine the best course of action.
Gat Y, Bachar GN, Zukerman Z, et al. Varicocele: a bilateral disease. Fertil Steril. 2004;81(2):424-429.
Schlegel PN. Evaluation of male infertility. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:3254-3276.
A 23-year-old healthy man has been unable to father a child. He and his wife have a workup for infertility. His wife’s reproductive function is normal. On physical examination both his testes are palpable in the scrotum and the testes and scrotum are normal in size, with no masses palpable. However, the spermatic cord on the left has the feel of a ‘bag of worms’. Laboratory studies show oligospermia. Which of the following conditions is this man most likely to have? Explain your answer.
B Testicular torsion
The answer is varicocele. Explain your answer.
250 words and 2 scholarly references