Cryptorchidism and Fertility

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Key points

  • Germ cell loss can be observed early in congenital cryptorchid testes, and the longer the testes remain undescended the more the testicular structure deteriorates. Therefore, orchiopexy at the age of 6 to 12 months is recommended to sustain as good spermatogenesis as possible.

  • Orchiopexy corrects the inappropriate temperature of the testis, but it may not reverse the damage that underlies cryptorchidism in the first place.

  • History of surgery for bilateral cryptorchidism has been associated with

Germ cell proliferation during childhood

Quantitative data on germ cell populations in fetal and childhood testes have been analyzed in rather few studies.1, 2, 3, 4 After migration of primordial germ cells to gonadal ridges, testicular cords are forming at 8 weeks of gestation, and germ cells inside the cords are called gonocytes. They normally move from the central part of the testicular cords to the basement membrane and form the spermatogonial layer by the age of 3 months. At that time, Adark and Apale spermatogonia start to

Germ cell loss in cryptorchidism

In cryptorchid testis, germ cell development is not normal, and even in the contralateral descended testis, abnormalities are common.6 The number of germ cells declines faster during the first 3 years after birth in the undescended testes than in the contralateral or normal testis.7, 8 This decline is also reflected by testicular size that lags behind in the undescended testis as compared with the normal one.9, 10 Timing of the treatment is an important determinant of testicular growth.

Effect of treatment on germ cells—human chorionic gonadotropin, gonadotropin-releasing hormone

Treatment with either human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) stimulates testicular growth and initiation of spermatogenesis both in the cryptorchid and descended testes. Part of the growth after hCG treatment is related to inflammatory reaction where vascular permeability in the testis increases and both erythrocytes and leukocytes leak into the interstitial tissue.16, 17 Apoptosis of germ cells can be observed after cessation of hCG treatment in a

Paternity rates

Paternity rates among men who had undergone orchiopexy because of unilateral or bilateral cryptorchidism were compared with a control group of men who had been operated on for another reason (the controls were matched for age at operation).28, 29 When including only men who had attempted to father a child (and who had attempted at least 12 months, if they were unsuccessful), the paternity rates were significantly reduced among formerly bilaterally cryptorchid men (success rate 65% of 49 men),

Sperm concentration and adult testicular size after cryptorchidism

Approximately half of men with persistent unilateral cryptorchidism and 0% of men with untreated bilateral cryptorchidism have normal sperm concentration.38, 39 According to an older review, based on studies in which orchiopexy was usually performed between the ages of 4 and 14 years, 57% and 25% of men treated (with orchiopexy and possible hormonal treatment) for unilateral or bilateral cryptorchidism, respectively, had normal sperm concentration in adulthood.38 In the study by Taskinen and

Acquired cryptorchidism and fertility

In addition to congenital cryptorchidism, there is also acquired form of cryptorchidism. Testicular ascent may be seen in boys with a retractile testis or in boys who have previously had ipsilateral inguinal operation (entrapment of the testis into the scar).49, 50 In addition, improper elongation of the spermatic cord due to fibrous remnant of the processus vaginalis and spasticity of the cremaster muscle have been proposed as possible causes for testicular ascent.51, 52 Acquired

Summary

Different types of evidence support the current recommendation of treatment of cryptorchidism during the first year of life or later on immediately at diagnosis to optimize the fertility potential of cryptorchid patients.

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References (65)

  • M.E. Chua et al.

    Hormonal therapy using gonadotropin releasing hormone for improvement of fertility index among children with cryptorchidism: a meta-analysis and systematic review

    J Pediatr Surg

    (2014)
  • M.T. Coughlin et al.

    Time to conception after orchidopexy: evidence for subfertility?

    Fertil Steril

    (1997)
  • M.T. Coughlin et al.

    Age at unilateral orchiopexy: effect on hormone levels and sperm count in adulthood

    J Urol

    (1999)
  • N. Jørgensen et al.

    Serum inhibin-B in fertile men is strongly correlated with low but not high sperm counts: a coordinated study of 1,797 European and US men

    Fertil Steril

    (2010)
  • P.A. Lee et al.

    Leydig cell function after cryptorchidism: evidence of the beneficial result of early surgery

    J Urol

    (2002)
  • C. Chilvers et al.

    Undescended testis: the effect of treatment on subsequent risk of subfertility and malignancy

    J Pediatr Surg

    (1986)
  • S. Taskinen et al.

    Early treatment of cryptorchidism, semen quality and testicular endocrinology

    J Urol

    (1996)
  • S. Taskinen et al.

    Effect of age at operation, location of testis and preoperative hormonal treatment on testicular growth after cryptorchidism

    J Urol

    (1997)
  • D.S. Engeler et al.

    Early orchiopexy: prepubertal intratubular germ cell neoplasia and fertility outcome

    Urology

    (2000)
  • S. Vinardi et al.

    Testicular function in men treated in childhood for undescended testes

    J Pediatr Surg

    (2001)
  • P.A. Lee et al.

    No relationship of testicular size at orchiopexy with fertility in men who previously had unilateral cryptorchidism

    J Urol

    (2001)
  • T.D. Clarnette et al.

    Incomplete disappearance of the processus vaginalis as a cause of ascending testis

    J Urol

    (1997)
  • J.A. Smith et al.

    The relationship between cerebral palsy and cryptorchidism

    J Pediatr Surg

    (1989)
  • J. van Brakel et al.

    Fertility potential in a cohort of 65 men with previously acquired undescended testes

    J Pediatr Surg

    (2014)
  • E.M. van der Plas et al.

    Long-term testicular volume after orchiopexy at diagnosis of acquired undescended testis

    J Urol

    (2013)
  • A. Meij-de Vries et al.

    Perioperative surgical findings in congenital and acquired undescended testis

    J Pediatr Surg

    (2010)
  • S.L. Rusnack et al.

    The ascending testis and the testis undescended since birth share the same histopathology

    J Urol

    (2002)
  • J. Muller et al.

    Fluctuations in the number of germ cells during the late foetal and early postnatal periods in boys

    Acta Endocrinol (Copenh)

    (1984)
  • R. Paniagua et al.

    Morphological and histometric study of human spermatogonia from birth to the onset of puberty

    J Anat

    (1984)
  • Y. Clermont

    Renewal of spermatogonia in man

    Am J Anat

    (1966)
  • D. Cortes

    Cryptorchidism–aspects of pathogenesis, histology and treatment

    Scand J Urol Nephrol Suppl

    (1998)
  • C. Kollin et al.

    Boys with undescended testes: endocrine, volumetric and morphometric studies on testicular function before and after orchidopexy at nine months or three years of age

    J Clin Endocrinol Metab

    (2012)
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    Funding Sources: This work was supported by the Academy of Finland, the Turku University Hospital, and Sigrid Jusélius Foundation.

    Conflict of Interest: The authors have nothing to disclose.

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