<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 32-year-old man and his wife are sent to a fertility specialist after trying to conceive for several years without success. They have had unprotected sex several times a week. He has no history of a serious illness and does not take any medications. There are no concerns about his libido or erections. His female partner is not on contraceptive medication and has a child from a previous marriage. At the clinic, his vitals are normal. Examination of the scrotum on the right side is normal, but on the left side there are many deep and superficial ducts or vessels that feels like a bag of worms on palpation. The lesion is more apparent when the patient bears down. Semen analysis shows a low sperm count with poor motility and an increased percentage of abnormal sperms. Which of the following is the most appropriate next step in management?? A: Intracytoplasmic sperm injection, B: Ligation of processus vaginalis, C: Microsurgical varicocelectomy, D: Pulsatile GNRH, E: No therapy at this time,  <response>: This is a question about male infertility. The key finding in the patient is a varicocele, which is described as a bag of worms feeling on the left scrotum. A varicocele can cause increased scrotal temperature and impaired spermatogenesis. The patient has low sperm count, poor motility, and increased abnormal forms, consistent with varicocele-related infertility. The choices include assisted reproductive techniques like intracytoplasmic sperm injection choice A, medical therapy like GnRH choice D, and surgical options like varicocelectomy choice C or ligation of processus vaginalis choice B. Ligation of processus vaginalis is done for inguinal hernia repair, not varicocele, so choice B is incorrect. The other options may be considered after varicocelectomy fails, but varicocelectomy is the initial treatment of choice for a clinically significant varicocele causing infertility.C: Microsurgical varicocelectomy 