Fertility after Unilateral Cryptorchidism

Miller, Karyn D.; Coughlin, Michael T.; Lee, Peter A.

doi:10.1159/000050005

Cited by 69 publications

(15 citation statements)

References 8 publications

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“…Cryptorchidism is a cause of azoospermia in adults with an incidence of 13% in unilateral cryptorchidism and 89% in untreated bilateral cryptorchidism (39). Orchidopexy performed before the age of 2 years minimizes germ cell loss, and when paternity is used as an index of fertility there is no significant difference in the ability or the time required to father a child between men with unilateral cryptorchidism (89.7%) and controls (93.7%) (40). However, there was a significant decrease in fertility in men with bilateral cryptorchidism (65.3%) (41).…”

Section: Discussionmentioning

confidence: 99%

Genomic and genetic variation in E2F transcription factor-1 in men with nonobstructive azoospermia

Jorgez

Wilken

Addai

et al. 2015

Fertility and Sterility

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Objective To identify gene dosage changes associated with non-obstructive azoospermia (NOA) using array comparative genomic hybridization (aCGH). Design Prospective study. Patients 110 men with NOA and 78 fertile controls. Settings Medical School Interventions None Main Outcome Measure The study has four distinct analytic components: aCGH, a molecular karyotype that detects copy-number-variations (CNV), Taqman-CNV assays to validate CNVs, mutation identification by Sanger sequencing and histologic analyses of testicular tissues. Results A microduplication at 20q11.22 encompassing E2F1 was identified in one of eight men with NOA analyzed using aCGH. CNVs were confirmed and an additional 102 men with NOA screened using Taqman CNV assays for a total of 110 NOA men analyzed for CNVs in E2F1. Eight of 110 (7.3%) NOA men had microduplications or microdeletions of E2F1 that were absent in fertile controls. Conclusions E2F1 microduplications or microdeletions are present in NOA men (7.3%). Duplications or deletions of E2F1 occur very rarely in the general population (0.011%), but E2F1 gene dosage changes, previously reported only in cancers, are present in a subset of NOA men. These results recapitulate the infertility phenotype seen in mice lacking or over-expressing E2f1.

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Section: Discussionmentioning

confidence: 99%

Genomic and genetic variation in E2F transcription factor-1 in men with nonobstructive azoospermia

Jorgez

Wilken

Addai

et al. 2015

Fertility and Sterility

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“…Furthermore, among men who had attempted paternity, virtually equal success of paternity was achieved in the previously unilateral group (89.7%) and the control group (93.7%) [1, 6]. …”

Section: Discussionmentioning

confidence: 99%

Infertility in Cryptorchidism Is Linked to the Stage of Germ Cell Development at Orchidopexy

et al. 2007

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Background: Cryptorchidism represents the most common endocrine disease in boys, with infertility frequently observed in unilateral as well as bilateral forms. In this study, we examined the role of Ad (dark) spermatogonia for fertility in cryptorchid boys. The hypothesis to be proven was that boys lacking Ad spermatogonia will develop infertility despite a successful orchidopexy at an early age. Methods: To estimate total sperm count, one of the most predictive parameters of male fertility, we analyzed the ejaculatein 218 cryptorchid men and correlated it with the developmental stage of their germ cells at the time of successful surgery. Results: Abnormal sperm concentration (<40 × 10⁶/ejaculate) was found in half of the patients under the study. 47.5% of unilateral and 78% of bilateral cryptorchid males had their sperm concentration in the infertility range according to the WHO standards. If transformation into Ad spermatogonia had occured, age-related differences in the fertility outcome was observed. The younger the unilateral cryptorchid boys were at surgery, the higher their sperm count. Age-related difference was not found in the group of cryptorchid men having had no A dark spermatogonia at time of surgery, indicating that in this group a successful orchidopexy is insufficient to prevent infertility development and, in particular, the development of azoospermia. Conclusion: The presence of Ad spermatogonia at surgery is an excellent prognostic parameter for future fertility. Cryptorchid boys lacking these cells will develop infertility despite successful orchidopexy at an early age.

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“…These histologic changes may play a role in the impaired fertility seen in unilateral, and more significantly, bilateral cryptorchidism. The overall probability of infertility among males with a history of unilateral cryptorchidism is 10%, which is similar to those without a history of cryptorchidism [17]. Neither the size nor the position of the testicle was related to paternity rates in the unilateral cryptorchid group.…”

Section: Treatmentmentioning

confidence: 91%

Current Management of Undescended Testes

Kurz

Tasian

2016

Curr Treat Options Peds

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Opinion Statement Undescended testes (UDTs) are a relatively common finding in newborn males, especially in those born prematurely. Upon discovering a non-intrascrotal testis, it is important to determine whether the testis is palpable or non-palpable and whether the finding is unilateral or bilateral. Imaging should not be used in this workup, as no current modality has been shown to be adequately sensitive or specific to aid in management decisions. Patients with UDTs diagnosed after 6 months of age should be referred to a specialist for correction so that surgery may be performed within 1 year thereafter. This allows testes to descend spontaneously if they are to do so while facilitating early intervention to decrease the risk of subfertility and testicular malignancy for those patients in whom spontaneous descent does not occur. The surgical approach is often dependent on the location of the testis on physical exam. Most orchiopexies for palpable testes are performed through an inguinal incision, although a scrotal approach can be safely utilized depending on the testis position. Diagnostic laparoscopy is most often used for non-palpable testes, as it not only allows for the identification of an atrophic or absent testicle, but it also provides an opportunity to perform an orchiopexy simultaneously should a viable testis be found. Hormonal therapy is not recommended for treatment of UDTs due to its low success rate, the incidence of secondary re-ascent, and the possible detrimental effects on spermatogenesis. Finally, patients with bilateral non-palpable UDTs require a more extensive preliminary evaluation to rule out congenital adrenal hyperplasia (CAH) and disorders of sexual development (DSD). This involves serum electrolytes, karyotype analysis and hormonal testing including a serum müllerian inhibiting substance (MIS), in order to determine if testicular tissue is present and functional.

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Fertility after Unilateral Cryptorchidism

Cited by 69 publications

References 8 publications

Genomic and genetic variation in E2F transcription factor-1 in men with nonobstructive azoospermia

Genomic and genetic variation in E2F transcription factor-1 in men with nonobstructive azoospermia

Infertility in Cryptorchidism Is Linked to the Stage of Germ Cell Development at Orchidopexy

Current Management of Undescended Testes

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