A 29-year-old man is evaluated for primary infertility of 2 years. Examination shows a soft scrotal swelling described as a bag of worms on the left side, increasing with standing. Semen analysis shows count 12 million/mL with progressive motility 28%. Repeat testing confirms these values. What is the MOST appropriate management?

• A Reassurance, as varicocele does not affect fertility
• B Empirical clomiphene citrate 25 mg alternate days
• C Immediate referral for IVF with ICSI
• D Varicocelectomy, because a clinically palpable varicocele with abnormal semen parameters warrants repair ✓

Explanation

Varicocele is the most common correctable cause of male infertility. Repair is indicated when the varicocele is clinically palpable, the couple has otherwise unexplained infertility or the male partner has abnormal semen parameters, and the female partner has normal fertility or a correctable issue. Subclinical varicoceles detected only on imaging are not operated upon, which is why examination findings matter here. Empirical clomiphene has no proven benefit, and assisted reproduction is offered after surgical correction fails.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.