Does Infertility Treatment Increase Male Reproductive Tract Disorder?

Bang, Jeong Kyoon; Lyu, Sang Woo; Choi, Jin; Lee, Dong Ryul; Yoon, Tae Ki; Song, Seung-Hun

doi:10.1016/j.urology.2012.12.003

Cited by 20 publications

(11 citation statements)

References 27 publications

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“…Some studies found a fivefold increased risk of hypospadias for a male newborn conceived by IVF/ICSI. While these conception methods are directly associated with low birth weight and prematurity, and both known to increase the occurrence of hypospadias, controversy still exists as to whether or not this is an indirect effect [4, 43]. …”

Section: Maternal and Other Possible Influencesmentioning

confidence: 99%

Hypospadias, all there is to know

2017

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Hypospadias is one of the most common congenital anomalies in men. The condition is typically characterized by proximal displacement of the urethral opening, penile curvature, and a ventrally deficient hooded foreskin. In about 70%, the urethral meatus is located distally on the penile shaft; this is considered a mild form that is not associated with other urogenital deformities. The remaining 30% are proximal and often more complex. In these cases, endocrinological evaluation is advised to exclude disorders of sexual differentiation, especially in case of concomitant unilateral or bilateral undescended testis. Although the etiology of hypospadias is largely unknown, many hypotheses exist about genetic predisposition and hormonal influences. The goal of hypospadias repair is to achieve cosmetic and functional normality, and currently, surgery is recommended between 6 and 18 months of age. Hypospadias can be corrected at any age with comparable complication risk, functional, and cosmetic outcome; however, the optimal age of repair remains conclusive. Although long-term overall outcome concerning cosmetic appearance and sexual function is fairly good, after correction, men may more often be inhibited in seeking sexual contact. Moreover, lower urinary tract symptoms occur twice as often in patients undergoing hypospadias repair and can still occur many years after the initial repair. Conclusion: This study explores the most recent insights into the management of hypospadias. What is Known: • Guidelines advise referral for treatment between 6 and 18 months of age.• Cosmetic outcome is considered satisfactory in over 70% of all patients. What is New: • Long-term complications include urinary tract symptoms and sexual and cosmetic issues.• New developments allow a more individualized approach, hopefully leading to less complications and more patient satisfaction.

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Section: Maternal and Other Possible Influencesmentioning

confidence: 99%

Hypospadias, all there is to know

2017

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“…However, there is limited 63646566676869 or no 70 evidence of an independent association between assisted reproduction procedures (ART) and development of cryptorchidism in the resulting child. In two studies a crude association between conception and cryptorchidism was substantially reduced after adjustment for birthweight.…”

Section: Assisted Reproductionmentioning

confidence: 99%

Risk factors for cryptorchidism

et al. 2017

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The condition known as cryptorchidism – undescended testis – is one of the most common congenital abnormalities found among males, and is one of the few known risk factors for testicular cancer (TC). Like testicular cancer, the key exposures in the occurrence of cryptorchidism remain elusive. Testicular descent is thought to occur during two hormonally-controlled phases – between 8–15 weeks and 25–35 weeks gestation – and while it is clear that a failure of testes to descend permanently is likely due to disruptions to one or both of these phases, the cause(s) and mechanism(s) of such disruption are still unclear. In this manuscript, we review the broad range of putative risk factors that have been evaluated in relation to the development of cryptorchidism to date, discuss their plausibility, and make suggestions regarding further approaches to understand aetiology. There are few exposures for which there is consistent evidence of an association with cryptorchidism; and in those cases where evidence appears unequivocal – for example, the relationship between cryptorchidism and gestational measures such as low birth weight – the measured exposure is likely to be a surrogate for the true causal exposure. The relative importance of each risk factor may vary considerably between mother/son pairs depending on an array of genetic, maternal, placental and foetal factors – all of which could vary between regions.

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“…Being born small for gestational age and having low birth weight are common features among patients with hypospadias and have also been suggested to increase the risk of subsequent male infertility and need of assisted reproductive technologies (ART) . Paternal subfertility and the use of ART are suggested risk factors for hypospadias, and it is plausible that subfertility traits in the father may be transferred to the son , , , …”

Section: Introductionmentioning

confidence: 99%

“…15,16 Paternal subfertility and the use of ART are suggested risk factors for hypospadias, and it is plausible that subfertility traits in the father may be transferred to the son. 17,18,19,20 As previously mentioned, few previous studies have investigated the paternity rate in men with hypospadias. When comparing men with hypospadias (N = 46) with age matched controls (N = 43), Aho et al found the mean number of children to be the same (mean 0.8 vs. 1.1).…”

Section: Introductionmentioning

confidence: 99%

Fertility in adult men born with hypospadias: A nationwide register‐based cohort study on birthrates, the use of assisted reproductive technologies and infertility

et al. 2019

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Background Fertility in men with hypospadias may be affected due to anatomical, surgical, or etiological factors and associated conditions. Fertility is further influenced by psychosocial and genetic factors, often shared within families. Objective To evaluate fertility in men born with hypospadias and assess confounding by familial factors. Materials and methods A population‐based cohort of 1.2 million men born in Sweden 1964‐1998, identified through national demographic and healthcare registers. Associations between hypospadias and (a) being a biological father, (b) conceiving through ART, and (c) diagnosis of male infertility were investigated in the full cohort with logistic regression models and Cox proportional hazard models, expressed as odds ratios (ORs) and hazard ratios (HRs), respectively, with 95% confidence intervals (CIs). A stratified proportional hazard model, conditional on sibling group, was used to control for shared familial confounding. Results Men with hypospadias, as a whole group, had a lower probability of having biological children (adjusted HR 0.87, 95% CI 0.83‐0.92). A significant association was present in both distal (adjusted HR 0.90, 95% CI 0.85‐0.96) and proximal hypospadias (HR 0.59, 95% CI 0.42‐0.81). Men with hypospadias more often became fathers through ART, regardless of concomitant cryptorchidism. The initial association between hypospadias and the diagnosis of infertility disappeared in sensitivity analyses excluding cryptorchidism. Discussion Men with hypospadias displayed lower birthrates as compared to their brothers and the general population. Mere birthrates may, however, be a questionable measure of fertility in a population using family planning. However, men with hypospadias were also at higher risk of reproducing through ART and did more often receive a diagnosis of male infertility. Altogether, these findings indicate impaired fertility in men with hypospadias. Conclusions Fertility in men with hypospadias is impaired, as shown by lower birthrates, increased use of ART and higher risk of receiving a diagnosis of male infertility.

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Does Infertility Treatment Increase Male Reproductive Tract Disorder?

Cited by 20 publications

References 27 publications

Hypospadias, all there is to know

Hypospadias, all there is to know

Risk factors for cryptorchidism

Fertility in adult men born with hypospadias: A nationwide register‐based cohort study on birthrates, the use of assisted reproductive technologies and infertility

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