Varicocele in Men with Infertility Evaluated by Scrotal Physical Examination and Scrotal Ultrasonography : Its Correlation with the Sperm Count

Abstract

Objective To investigate 1) the correlation of scrotal physical examination comparing to scrotal ultrasonography in the detection of varicocele in men with infertility, depicting scrotal ultrasonography as the gold standard, 2) the clinical significance of ultrasound diagnosed varicocele by comparing incidence of oligospermia in patients with and without varicocele.

Subjects A total of 110 men with infertility more than 1 year duration who were referred to the infertility clinic for the investigation and treatment of infertility.

Main outcome measures Sensitivity, specificity, positive predictive value, negative predictive value of scrotal physical examination in the detection of varicocele in men with infertility depicting scrotal ultrasonography as the gold standard and incidence of oligospermia in patients with and without varicocele.

Results The scrotal physical examination in the detection of clinical varicocele has sensitivity of 73.90%, specificity of 90.60% and positive predictive value of 85.00% with negative predictive value of 82.80%. Of total 110 patients, 64 had normal ultrasound scans. Twenty-two of 64 (34.38%) were found to have oligospermia. Among 46 patients with varicoceles diagnosed by ultrasonography, 26 (52.56%) were found to have oligospermia. Significantly, more patients with varicoceles were found to have oligospermia (P = 0.034). 

Conclusion Physical examination of the scrotum which is a noninvasive, inexpensive, and convenient technique remains an appropriate screening test with reasonable accuracy but ultrasound examination should be used in doubtful cases especially those with difficulty to detect this condition by scrotal physical examination or those in whom we suspect subclinical varicoceles. Significantly more patients with varicocele were found to have oligospermia than those without varicocele.