Fertility after Bilateral Cryptorchidism

Abstract

Purpose: Evaluation of the fertility of a cohort of formerly bilaterally cryptorchid men in comparison with a group of formerly unilaterally cryptorchid men, and a group of control men. Materials and Methods: Using a detailed questionnaire concerning paternity and factors related to paternity, a cohort of formerly bilateral cryptorchid men were studied and compared with men who had undergone orchiopexy for unilateral cryptorchidism, and a group of control men. All study subjects had had surgery at the Children’s Hospital of Pittsburgh, Pittsburgh, Pa., between 1955 and 1975. A subset of the full cohort underwent clinical evaluation that included a physical examination, serum hormonal determination and semen analyses. Results: Paternity rates are significantly lower among the formerly bilaterally cryptorchid men who have attempted to father a child (65.3%) as compared to the formerly unilaterally cryptorchid (89.7%; p < 0.001) and control men (93.2%; p < 0.001). Differences in the ability to father children are also apparent when semen and hormone levels are compared between the three groups. The bilateral group has significantly lower sperm density and inhibin B levels, and higher FSH and LH levels, than the unilateral and control groups. Conclusions: Men born with bilateral cryptorchidism have severely compromised fertility in adulthood. This reduction in fertility is clearly shown in comparisons of both paternity rates, and in semen and hormone analyses, between the formerly bilateral, formerly unilateral, and control groups.

Electronic Data Base Systems Support the Evaluation of Male Infertility Factors, Example Cryptorchidism

“…Our study demonstrated a significantly lower sperm count in cryptorchid men compared with semen donors, which confirms findings of others [5,14,22,27]. Several factors have been identified to play a role for the impaired spermatogenesis.…”

“…The conception rate is regarded as a superior overall measure of fertility than semen analysis [5]. However, it should be noted that the biological father may be someone other than the mother's partner [35,36].…”

“…It is associated with disturbances of fertility [4,5], testicular neoplasm [6], hernias and torsions [7]. The data concerning the effects of cryptorchidism on subsequent fertility reveal discrepancies in the literature [8].…”

“…Fertility in patients with cryptorchidism may depend upon several factors, such as combination with other genital diseases, whether the cryptorchidism is unilateral or bilateral, degree of maldescensus testis [13], and, especially, results and age of correction [5]. Men with unilateral undescended testis fathered significantly more children than patients with bilateral undescended testes [14].…”

Surgical vs. Untreated Cryptorchidism: Effects on Fertility

“…It has been postulated that the delay in the correction of the maldescended testes will cause more pronounced morphological alterations. Nevertheless, this assumption has not been fully established [12]. Cortes et al [4] came to the conclusion that unilateral orchiopexy at ages 1 to 2 years may be no better than at ages 2 to 12 years in regard to subsequent fertility potential.…”