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The following grading scale is used to define the severity of a varicocele: Grade 0 (subclinical): seen on ultrasound only but not physically palpable Grade I: palpable only when the patient is performing the Valsalva maneuver Grade II: palpable with or without valsalva maneuver Grade III: able to visualize varicocele through scrotum (colloquially descried as a bag of worms appearance) Certain causes of male factor infertility such as congenital bilateral absence of the vasa deferens (CBAVD) and varicocele are established by physical examination

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