Please enable JavaScript in your browser to complete this form. - Step 1 of 3 Layout How severe is your varicocele? 0 - I don't know 1 - No varicocele 2 - Subclinical 3 - Grade 1 (mild) 4 - Grade 2 (moderate) 5 - Grade 3 (severe) How severe is your varicocele? Selected Value: 0 How severe is your varicocele?0 - I don't know1 - No varicocele2 - Subclinical3 - Grade 1 (mild)4 - Grade 2 (moderate)5 - Grade 3 (severe) How severe is your varicocele?0 - I don't know1 - No varicocele2 - Subclinical3 - Grade 1 (mild)4 - Grade 2 (moderate)5 - Grade 3 (severe)NextUpdating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes. Layout 2 How severe is your infertility? 0 - I don't know 1 - Normal fertility 2 - Low count 3 - Low morphology 4 - Low motility 5 - Azoospermia (zero sperm) How severe is your infertility? Selected Value: 0 PreviousNext Layout 3 How bad is your testicular pain? 0 - No Pain 1 - Mild Pain 2 - Moderate Pain 3 - Severe Pain 4 - Very Severe Pain 5 - Worst Pain Possible How bad is your testicular pain? Selected Value: 0 PreviousSubmit