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Background: Varicocele, defined as an abnormal enlargement and tortuosity of the veins in the pampiniform plexus, is the most common cause of correctable male infertility that might increase chance of fertility even in presence of further male factor infertility causes. While it is well known to be reason of fertility in male and is easy to treat, here we present a case with 20 years of infertility due to missed opportunity of varicocelectomy.
Case Presentation: A 39-year-old male patient with a family history of infertility for about 20 years was referred for azoospermia and stated that after two testicular biopsies and failure to obtain sperm in one of the equipped infertility treatment centers, he was recommended to receive a donated embryo, but he wanted to have his biological child genetically. In the history taken, he had a history of mild left varicocele and no other clinical problems, and mild bilateral varicocele was evident on examination. Karyotype and Y chromosome examination were normal, and hormonal tests and gonadotropin and testosterone levels were within normal limits. Semen volume was 1 ml in two tests one month apart, and semen was alkaline. The patient underwent microscopic bilateral varicocelectomy with an inguinal incision. The patient underwent fluoroscopy, vasography, which showed distal dilatation of both Vas deferens. Diluted methylene blue solution was also injected into the vas deferens and Folley was fixed. But the urine color did not turn blue, so the patient's position was changed to lithotomy and the patient underwent resection of the ejaculatory duct via the urethra, that is the Verumontanum was resected with a cautery-cutting cautery. Three months later, the patient presented with a completely normal semen analysis. The patient was advised to try to conceive at least four months after the operation. Two months later, pregnancy occurred again, and after 9 months, a healthy male fetus was born by cesarean section.
Conclusion: This study demonstrates that varicocele treatment can significantly improve fertility parameters and enhance the chances of successful conception in affected patients. The most important suggestion of this case report is to highlight the importance of timely diagnosis and treatment of varicocele as a correctable cause of male infertility. Unfortunately, our patient suffered from infertility for 20 years due to not undergoing varicocelectomy. Even obstruction treatment may not necessarily be needed in this case, as a sole varicocelectomy might make sperm extraction possible for further in vitro procedures.
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