What is the most likely cause of infertility in a 32-year-old man with a nontender clustered mass above the left testis?

The clinical scenario describes a 32-year-old man presenting with a nontender clustered mass located above the left testis. This presentation is highly suggestive of a varicocele, which is characterized by an enlargement of the veins within the scrotum due to impaired venous drainage.

Varicoceles are known to be associated with male infertility, as they can lead to increased temperature in the testes, which negatively affects spermatogenesis and testosterone production. The nontender nature of the mass and its location above the testis are typical findings in cases of varicoceles. They are often identified during physical examination when the scrotum is examined with the patient standing.

In contrast, testicular torsion usually presents with an acute, severe scrotal pain and swelling, which intensifies in severity and requires urgent intervention. A hydrocele is generally a fluid-filled sac around the testicle, often presenting as a painless swelling but it does not typically result in infertility. An inguinal hernia can present with a palpable mass, but it often produces discomfort or pain, and is not directly linked to infertility in the same way that varicoceles are.

Thus, the findings presented in this scenario align most closely with