Semen quality and gonadotropin levels in patients operated upon for cryptorchidism

Abstract

In a long-term follow-up study we compared preoperative testicular position, age at orchiopexy, and morphology of testicular biopsies investigated at orchiopexy to sperm analysis results, testicular volume, and serum follicle-stimulating hormone and luteinizing hormone levels at follow-up in 46 men with a history of surgical correction of cryptorchidism in childhood. They had undergone orchiopexy at age 1.5-12.0 years, 24 for unilateral and 22 for bilateral cryptorchidism. Eleven (46%) of the 24 patients with unilateral and 7 (32%) of the 22 with bilateral undescended testes had a normal sperm analysis, whereas in men with impaired spermiogenesis oligo-asthenozoospermia was the predominant feature. Three (13.6%) patients with bilateral cryptorchidism showed azoospermia, but none of the patients with unilateral cryptorchidism did. Neither the age at orchiopexy nor the average germ-cell count per cross-sectioned seminiferous tubule of testicular biopsies examined at orchiopexy correlated significantly with subsequent sperm analysis results or gonadotropin levels at follow-up. The pretreatment testicular position ("testicular position value") has a high prognostic value for prediction of subsequent sperm analysis results and serum gonadotropin levels.

Clinical aspects of histological and hormonal parameters in boys with cryptorchidism

“…According to available follow‐up studies of men treated for unilateral cryptorchidism, the reported prevalence of azoospermia ranges from 0% to 14%, the lower rates being quite similar to findings in the general population [9,21,185,186,187,188,189,190]. However, comparison data from the general population also include men with a history of cryptorchidism, and as 2.5% of boys in the western world undergo surgery for cryptorchidism and about 5% exhibit cryptorchidism in at least some years, findings similar to the general population does not exclude the impact of cryptorchidism on azoospermia.…”

“…Undoubtedly, untreated bilateral cryptorchidism results in a high, up to 89%, incidence of azoospermia [1,21]. The incidence of azoospermia in men with former bilateral cryptorchidism has been detected between 10% and 46% [19,21,179,187,188,190]. Cryptorchidism is a heterogeneous disease that can cause deleterious effects on reproductive parameters.…”

“…When obtaining testicular biopsies to assess the fertility potential, the biopsy may not reflect the total testicular parenchyma and in unilateral cases only mirror the undescended (diseased) testis. Because of the heterogeneity of the germ cells in the undescended testes, we quantitated the whole biopsy with at least 100 and 250 cross-sectional tubules for G/T and AdS/T, respectively, which is higher than other studies [41,50,187,202,238,241]. Biopsies with fewer transversal tubules were excluded.…”

“…Equivalently, others have reported that G/T at the time of surgery of unilateral and bilateral cryptorchid patients analyzed together correlated to later sperm concentration [19,200,201,202,203]. However, others did not find any correlation between prepubertal histological findings and adult semen parameters [187,204] but they only quantified the “tubular fertility index” defined as the number of tubules with spermatogonia/total number of counted tubules.…”

Germ cell development in the descended and cryptorchid testis and the effects of hormonal manipulation

“…The effect of age at orchidopexy on sperm counts in adulthood has been evaluated [17][18][19][20][21][22], but results have been inconclusive because the age at orchidopexy in all these studies was over 2 years. Only one study [23] concluded that early orchidopexy in patients younger than 2 years was not necessarily essential, as their patients had similar outcomes when operated prior to 6 years old.…”