Reproductive Markers of Testicular Function and Size During Puberty in Boys With and Without a History of Cryptorchidism

Abstract

Context Longitudinal data on levels of hypothalamic-pituitary-gonadal axis hormones and insulin-like growth factor I (IGF-I) during puberty in boys with a history of cryptorchidism are largely missing. Objective To compare pubertal hormone levels between boys with a history of congenital cryptorchidism who experienced spontaneous testicular descent or underwent orchiopexy and boys without a history of cryptorchidism. Design Prospective, longitudinal pubertal follow-up every 6 months (2005 to 2019) Setting A nested case control study within a population-based birth cohort Participants 109 Finnish boys, including boys with a history of unilateral cryptorchidism who underwent orchiopexy (n = 15), unilateral cryptorchidism who had spontaneous testicular descent (n = 15), bilateral cryptorchidism who underwent orchiopexy (n = 9), bilateral cryptorchidism who had spontaneous testicular descent (n = 7), and controls (n = 63) Main Outcome Measures Serum reproductive hormone levels and testicular volume Results From around onset of puberty, boys with bilateral cryptorchidism who underwent orchiopexy had significantly higher follicle-stimulating hormone (FSH) and lower inhibin B levels than controls. Boys with unilateral cryptorchidism who underwent orchiopexy had significantly higher FSH than controls, whereas inhibin B levels were similar. Testosterone, luteinizing hormone, insulin-like factor 3, and IGF-I were generally similar between groups. Testicular volume of boys with unilateral or bilateral cryptorchidism who underwent orchiopexy was smaller than that of the controls from one year after pubertal onset (p < 0.05). Conclusions Cryptorchid boys, in particular those with bilateral cryptorchidism who underwent orchiopexy, had altered levels of serum biomarkers of Sertoli cells and germ cells and smaller testicular volumes compared with controls.

Cryptorchidism and puberty

“…The between-group IGF-I and insulin-like growth factor-binding protein-3 (IGFBP-3) levels were generally similar from prepuberty to the end of puberty. This indicates that the growth axis is not affected by a history of cryptorchidism ( 42 ).…”

“…When the combined testicular volume of both testes and the previous orchiopexy was considered, the combined testicular volume of boys with a history of operated unilateral or bilateral cryptorchidism was smaller than that of controls from approximately 1 year after pubertal onset to full pubertal maturation ( 42 ). Figure 1 illustrates pubertal testicular growth in boys with a history of surgically treated bilateral cryptorchidism and controls.…”

“…This study showed elevated basal and GnRH-stimulated plasma FSH levels in boys with a history of cryptorchidism as compared with the normal reference range, indicating a primary testicular defect affecting Sertoli cells and/or germ cells. The Finnish birth cohort study additionally investigated the effects of orchiopexy and spontaneous testicular descent on hormone levels ( 42 ). The study followed 30 boys with a history of unilateral cryptorchidism and 16 boys with a history of bilateral cryptorchidism who had experienced spontaneous testicular descent or underwent orchiopexy and 63 non-cryptorchid boys from the age of 8.5 years to the end of puberty.…”

“…Considering the normal testicular volume in boys with a history of unilateral cryptorchidism and spontaneous testicular descent, the number of Sertoli cells and germ cells is probably preserved, but the cell function is impaired, in these boys. In boys with a history of bilateral cryptorchidism, particularly in those who underwent orchiopexy, higher FSH and lower inhibin B levels than those of non-cryptorchid boys from 0.5–1 year after pubertal onset to the time of full pubertal maturation were shown, indicating decompensated Sertoli cell and/or germ cell dysfunction and/or more severely decreased number of these cells in bilateral cryptorchidism ( 42 ). In another study, boys with a history of unilateral cryptorchidism and compensatory hypertrophy of the contralateral descended testis had higher basal and LHRH-stimulated FSH levels than normal boys from prepuberty to the end of puberty ( 53 ).…”

“…Figure 2 illustrates the alterations of HPG axis hormones in boys with a history of bilateral cryptorchidism who underwent orchiopexy in childhood ( 42 ).…”