PHARMACIST-LED IDENTIFICATION AND MANAGEMENT OF DRUG THERAPY PROBLEMS IN A PATIENT WITH PRIMARY MALE INFERTILITY SECONDARY TO BILATERAL VARICOCELE: A CASE REPORT

Timi Fiekumo Buseri, Otoworo, Woyengidengimodo Vanessa, Pius Excellence, Vivian Nkeiru Ben-Eledo, Owonaro A. Peter*

ABSTRACT

Background: Varicocele is the most surgically correctable cause of male infertility, implicated in approximately 35–40% of primary and up to 80% of secondary male infertility cases globally. The condition arises from incompetent valves within the pampiniform venous plexus, resulting in retrograde blood pooling, scrotal hyperthermia, elevated reactive oxygen species (ROS), and progressive sperm DNA fragmentation. Despite the reversibility of varicocele-induced infertility following surgical repair, the pharmacist’s role in perioperative optimisation and post-surgical reproductive care remains largely under-described in the literature, particularly in sub-Saharan African settings. Case Presentation: A 39-year-old Nigerian male — a vulcanizer by occupation — presented to the Surgical Outpatient Department of Federal Medical Centre, Yenagoa, with a 10-year history of primary infertility. He had no significant comorbidities, reported no tobacco or alcohol use, and had no known drug or food allergies. Past surgical history was notable for left inguinal herniorrhaphy performed 33 years prior. Scrotal ultrasound confirmed a “bag of worms” appearance within the left pampiniform plexus, diagnostic of bilateral varicocele. Semen analysis revealed severe oligoasthenozoospermia: active motility 10%, sluggish motility 30%, and non-motility 60%. Complete blood count, electrolytes, urea, and creatinine were all within normal limits. A diagnosis of primary male infertility secondary to bilateral varicocele was established, and bilateral varicocelectomy was performed.

Keywords:

Male infertility; varicocele; varicocelectomy; pharmaceutical care; drug therapy problems; NSAID gastroprotection; ashwagandha toxicity; antioxidant therapy; oligoasthenozoospermia; Nigeria

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