Case Studies

Chapter 13 Case 1

A couple present to the infertility clinic with 18 months of failure to conceive. No cause was found in the female partner after she was investigated by a gynaecologist. The man is 35 years old with no significant past medical history. Examination revealed a large left varicocele. This was visible through the scrotal skin on standing. Both testicles felt normal. Sperm analysis showed: volume 1.5 mL, pH 7.3, motility 25%, count 8 × 106, normal forms 3%.

• 1. What is the diagnosis?

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  Correct answer:

  Oligo-astheno-teratozoospermia (OAT).

• 2. What is the most probable cause of his subfertility?

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  Correct answer:

  Varicocele

• 3. What is the grade of his varicocele on the left side?

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  Correct answer:

  Grade 3 (0: subclinical, 1: palpable only with Valsalva manoeuvre, 2: palpable without Valsalva manoeuvre, 3: visible through scrotal skin)

• 4. What are the treatment options of varicoceles?

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  Correct answer:

  • Embolisation
  • Surgical: high retroperitoneal ligations, inguinal, subinguinal with microscopic assistance (gold standard) and laparoscopic.

• 5. What is the percentage expected improvement in the semen parameters post varicocele treatment?

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  Correct answer:

  50�70%.