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Varicocele Lifestyle & Risk Assessment Survey

* Indicates required field

Full name *

Email *

Age *

Weight (specify lb/kg) *

Height (specify m/ft) *

Country *

About Your Varicocele

Varicocele grade *

Varicocele type *

Any additional details *

Fertility

Have you had a sperm analysis? *

If "No", then are you willing to have one done? *

Semen volume *

Semen consistency (thickness) *

Sperm count *

Sperm motility *

Normal morphology *

Abnormal morphology *

Furctose *

pH (acidity) *

Immature sperm *

Number of white blood cells (cells that indicate an infection) *

Hormones

Do you have gynecomastia? *

Have you had a hormone analysis? *

If "No", then are you willing to have one? *

Testosterone level (ng/dL) *

Anything else related to hormones? *

Testicles

Left testis volume (mL) *

Right testis volume (mL) *

How does your left testicle feel to the touch (e.g. firm, plump, squishy, etc.)? *

How does your right testicle feel to the touch (e.g. firm, plump, squishy, etc.)? *

Varility

Untitled *

Submit

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​Varicocele Lifestyle & Risk Assessment Survey