Fertility potential in adult men treated for uncorrected bilateral cryptorchidism: A systematic literature review and analysis of case reports

Abstract

Objective Reports of adult orchidopexy for bilateral undescended testicles (bUDT) are sparse, and fertility outcomes are not well established. Our aim was to determine prognosis for restoration of spermatogenesis among adult men (≥18 years) undergoing orchidopexy for bUDT. Methods A systematic literature review, conforming to the PRISMA statement, was conducted using the PubMed/MEDLINE and EMBASE databases through March 2020 using search terms "adult” AND “bilateral orchidopexy" OR "bilateral cryptorchidism.” Relevant referenced articles from non‐indexed journal were identified by Google Scholar search and additionally included. Results Fifty‐seven publications including adult men with uncorrected bilateral UDTs were identified. Baseline semen analysis was reported in 157 men, all of whom demonstrated azoospermia. Testosterone values were reported in 82 cases and were normal in 89%. Germ cells could not be identified in 72.6% of histologic specimens from 62 testicles. Abdominal testicles more frequently lacked germ cells (90%, p = 0.038) on univariate analysis. Eleven cases identified ejaculated spermatozoa following adult bilateral orchidopexy (8 publications). Sperm extraction (TESE) during orchidopexy or orchiectomy was reported in 13 men without success. Delayed TESE (median 10 months) was performed in 22 persistently azoospermic men with success in 10 (45.5%), none of whom had abdominal testicles prior to orchidopexy. Six men experienced successful paternity via natural conception (3) or assisted reproduction (3). Conclusion Fertility is possible in adult men with inguinal bUDT following orchidopexy. Subsequent sperm retrieval may involve ejaculated specimens or delayed TESE. TESE performed prior to or at time of orchidopexy is unlikely to be of benefit.

miRNA-210 increased apoptosis of testicular tissues in cryptorchidism mice model through INHBB-Smad2/3 signaling pathway

“…It has been reported that 20% of azoospermic or infertile men have a history of cryptorchidism, which may lead to azoospermia despite early surgical correction [18]. Therefore, surgery does not appear to repair pre-existing pathological lesions, and some patients still show low fertility after adulthood [19]. In addition, cryptorchidism is the most obvious characteristic risk factor for testicular cancer, and there is evidence that even after surgical treatment, there is still a risk of cancer 4-5 times higher than that in the healthy population [20,21].…”

Impact of Men with Undescended Testis on Fertility and Hormonal Function Promoting Hypogonadism

“…28 Men with bilateral UDT are 3.5 times more frequent of being infertile than unilateral UDT men and six times riskier than men without UDT. 5,27 The occurrence of infertility in UDT is associated with the failure to transform gonocytes to Ad spermatogonia. 29 Early in life, the conversion of neonatal gonocytes into Ad spermatogonia is impeded, and this causes a deficiency of germ cells for post-pubertal spermatogenesis and infertility.…”

“…4 The inconsistent results of management are also influenced by the definitive etiology of UDT which remains unknown and the anomaly is considered multifactorial including anatomical, endocrine, environmental, genetic, and mechanical factors. 5 Undescended testes have a close correlation with infertility as well as testicular malignancy. The abdominal cavity's temperature and the groin canal is almost 2°C higher than the scrotum, it is possibly the reason why spermatogenesis is impeded and germ cells are harmed.…”

“…6 In addition, it was found that the number of Leydig cells in UDT was reduced and could cause infertility. 5 It is evident that the risk of infertility and testicular germ cell tumors (TGCT) are consistently higher for men with a history of UDT. However, to our best knowledge, studies on the long-term effects of UDT on hormones and hypogonadism in UDT adults are limited and have inconsistent results.…”

Bilateral congenital cryptorchidism and unilateral Leydig cell tumor in an adult presenting with gynecomastia and primary infertility: A case report

“…While mostly unilateral, cases of bilateral cryptorchidism may be present and have been rarely reported [7] . Here we report a case of LCT in a young adult male with bilateral congenital cryptorchidism who presented with gynecomastia and infertility.…”