Fertility after unilateral cryptorchidism. Paternity, time to conception, pretreatment testicular location and size, hormone and sperm parameters.

OBJECTIVE: To further evaluate whether fertility is decreased among a cohort of men with previous unilateral cryptorchidism as compared with a control group of men. SUBJECTS AND METHODS: Formerly unilateral cryptorchid men who had undergone orchiopexy between the years of 1955 and 1975 at the Children's Hospital of Pittsburgh and a control group of men who were matched for age of an unrelated surgery at the same institution were evaluated by review of medical records and by completion of a questionnaire. 359 previously cryptorchid men were identified as having attempted paternity. Of these men, 320 had information concerning preoperative testicular location and 163 for preoperative testicular size. 106 of these men had levels of testosterone, inhibin B, FSH, and LH measured, while 95 of the men had semen analyses. RESULTS: Among men who had attempted paternity, there was no statistical difference in success of paternity between the previously unilateral group (89.7%) and the control group (93.7%). There was no difference in the mean time to conception (7.1 +/- 0.7 months for the unilateral group vs. 6.9 +/- 2.3 for the control group). Within the unilateral group in regard to success at paternity, no difference was found compared with the age of orchiopexy, preoperative testicular location, or preoperative testicular size. Inhibin B levels were lower among the unilateral group. FSH, LH, testosterone, sperm density, motility and morphology were not different, but considerable variation was noted within the cryptorchid group. CONCLUSIONS: In this continued evaluation of a cohort of previously cryptorchid men who had undergone unilateral orchiopexy, paternity does not appear to be significantly compromised after unilateral cryptorchidism. Unilateral cryptorchidism appears to be one of several factors contributing to infertility, similar to those found in the general population. No correlation was found between success at paternity and the age of orchiopexy, preoperative testicular size or preoperative testicular location. Inhibin B levels were lower while FSH, LH, T and sperm parameters did not differ.

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

PURPOSE: We determined whether testicular size at orchiopexy is predictive of fertility potential and whether size correlates with sperm parameters, hormone levels or testicular volume in adulthood. MATERIALS AND METHODS: Testicular size obtained from the operative notes of patients who underwent unilateral orchiopexy was classified as normal, small or large for age. These data were compared with outcome data. Paternity data were included on 166 men who reported achieving or unsuccessfully attempting paternity for 12 or more months. Of the men 49 provided blood for hormone level measurement, 43 underwent semen analysis and in 29 testicular volume was determined. RESULTS: In the 166 men, including 98, 65 and 3 with small, normal and large testes for age at orchiopexy, respectively, there was no difference in paternity based on testicular size. Of those who achieved paternity time to conception did not differ based on size. Mean age at surgery also did not differ, nor did the percent of small versus normal testes in the age categories 0 to 2, 3 to 5, 6 to 8 and 9 to 11 years. There was no difference in men with small or normal testicular size at surgery in mean luteinizing hormone, follicle-stimulating hormone, testosterone or inhibin B. Sperm density, motility and morphology, and volume in adulthood of a previously undescended testis, previously descended testis or previously undescended and descended testes did not differ in these 2 groups, although the previously undescended testis was smaller than the contralateral testis. CONCLUSIONS: In men with a history of unilateral cryptorchidism small testicular size at orchiopexy is not associated with decreased paternity (89.8%), abnormal hormone levels, a lower sperm count or decreased testicular volume in adulthood.

Fertility after bilateral cryptorchidism. Evaluation by paternity, hormone, and semen data.

PURPOSE: Evaluation of the fertility of a cohort of formerly bilaterally cryptorchid men in comparison with a group of formerly unilaterally cryptorchid men, and a group of control men. MATERIALS AND METHODS: Using a detailed questionnaire concerning paternity and factors related to paternity, a cohort of formerly bilateral cryptorchid men were studied and compared with men who had undergone orchiopexy for unilateral cryptorchidism, and a group of control men. All study subjects had had surgery at the Children's Hospital of Pittsburgh, Pittsburgh, Pa., between 1955 and 1975. A subset of the full cohort underwent clinical evaluation that included a physical examination, serum hormonal determination and semen analyses. RESULTS: Paternity rates are significantly lower among the formerly bilaterally cryptorchid men who have attempted to father a child (65.3%) as compared to the formerly unilaterally cryptorchid (89.7%; p < 0.001) and control men (93.2%; p < 0.001). Differences in the ability to father children are also apparent when semen and hormone levels are compared between the three groups. The bilateral group has significantly lower sperm density and inhibin B levels, and higher FSH and LH levels, than the unilateral and control groups. CONCLUSIONS: Men born with bilateral cryptorchidism have severely compromised fertility in adulthood. This reduction in fertility is clearly shown in comparisons of both paternity rates, and in semen and hormone analyses, between the formerly bilateral, formerly unilateral, and control groups.

Inhibin B: comparison with indexes of fertility among formerly cryptorchid and control men.

Infertility may be a consequence of cryptorchidism. We previously reported, using a large study cohort, that 38% of formerly bilateral cryptorchid men, 10% of unilateral cryptorchid men, and 5% of the control group were infertile. Men from this cohort donated blood and semen samples for inhibin B, FSH, LH, testosterone, free testosterone, and semen analyses. Results are reported comparing the entire group; some comparisons are based on normal or low sperm density. Data are also presented for men who had fathered children or had unsuccessfully attempted paternity. Mean (+/-SD) inhibin B levels were lower for the cryptorchid men (109 +/- 59 pg/mL) than the control men (153 +/- 60; P < 0.001), and FSH levels were higher (7.4 +/- 6.2 and 4.0 +/- 3.2; P < 0.0001). Inhibin B levels correlated with all other parameters for the cryptorchid group; however, correlations for the control group were only found with gonadotropins. Among the cryptorchid men, levels were significantly greater among men with normal sperm counts than men with low sperm counts (124 +/- 47 vs. 75 +/- 48 pg/mL; P < 0.0001). No difference was present for the control group (155 +/- 61 vs. 149 +/- 63 pg/mL). When the fertile group (based on paternity) vs. the infertile group (based on attempted paternity) were compared, significant differences were found for the cryptorchid group (117 +/- 62 vs. 73 +/- 52 pg/mL; P < 0.03), but not the control group (163 +/- 62 vs. 146 +/- 73 pg/mL). These data reveal relationships not apparent among the control group of men, which includes infertile men. Inhibin B data suggest that a larger portion of formerly cryptorchid men have compromised testicular function than indicated by paternity data. Low levels of inhibin B among individuals are an indication of diminished seminiferous tubule function and thus compromised potential for fertility. Low inhibin B levels together with elevated FSH levels and decreased sperm density are indicative of a high risk of infertility.

Paternity and hormone levels after unilateral cryptorchidism: association with pretreatment testicular location.

PURPOSE: We determined differences in paternity and levels of the hormones inhibin B, follicle- stimulating hormone, luteinizing hormone, testosterone and free testosterone based on the preoperative location of the undescended testis in men with previous unilateral cryptorchidism. MATERIALS AND METHODS: Testicular location was determined by a review of the medical records and paternity or attempted paternity using a detailed questionnaire administered to 320 men with previous unilateral cryptorchidism. In 103 cases we performed semen analysis and measured the levels of the hormones inhibin B, luteinizing hormone, follicle-stimulating hormone, testosterone and free testosterone. Paternity, sperm count and hormonal parameters were compared with cryptorchid testicular location using analysis of variance and chi-square analysis. Logistic regression was done to analyze pretreatment testicular location as a risk factor for infertility. RESULTS: Paternity, duration of attempted conception in men who achieved paternity, sperm count and hormone levels did not differ based on pretreatment abdominal, internal ring, inguinal canal, external ring, upper scrotum or ectopic testicular location. The overall paternity rate was 90% with the lowest rate of 83.3% in the abdominal group. More than 12 months were required to achieve conception in 28.9% of the study group overall and in 39.4% of the abdominal group. Varicocele and a partner with fertility problems were risk factors for infertility, while abdominal testicular location caused borderline significant risk. CONCLUSIONS: Preoperative testicular location in men with previous unilateral cryptorchidism is not a major determinant of fertility according to paternity, sperm count or hormone levels.

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

PURPOSE: We determined whether there are differences in hormone levels, such as inhibin B, follicle-stimulating hormone (FSH), luteinizing hormone and testosterone, and sperm density in men with a history of unilateral cryptorchidism as stratified by age at orchiopexy. MATERIALS AND METHODS: A total of 84 men with a history of unilateral cryptorchidism presented to our institution for serum hormone measurement and semen analysis. These parameters were compared using Pearson's correlations and analysis of variance among 4 groups stratified according to age at orchiopexy (range 1 month to 11 years). RESULTS: Comparison by Pearson's correlation analysis showed that age at orchiopexy significantly correlated inversely with inhibin B (r = -0.274, p = 0.012) and positively correlated with FSH (r = 0.229, p = 0.036). Comparison of mean hormone levels and sperm density by analysis of variance for linear trend revealed a significant relationship between age at surgery with inhibin B (p = 0.032) and testosterone (p = 0.029), while sperm density, FSH and luteinizing hormone were not significantly related. Post hoc comparison of individual means at surgery and at the time of this study demonstrated a significantly higher inhibin B level in the youngest age group than in 2 of the 3 older groups. CONCLUSIONS: Men who previously had unilateral cryptorchidism and who underwent orchiopexy by age 2 years have higher inhibin B and lower FSH profiles than those who underwent surgery later in life. This finding suggests an overall beneficial effect of early orchiopexy in boys born with unilateral cryptorchidism.

Testicular suture: a significant risk factor for infertility among formerly cryptorchid men.

BACKGROUND/PURPOSE: Although fertility is decreased after cryptorchidism, the importance of risk factors, including parenchymal testicular suture, is unknown. The aim of this study was to examine the relationship between parenchymal testicular suture and failure to conceive a child for 1 year or longer among formerly cryptorchid men. METHODS: Men who underwent orchidopexy between 1955 and 1972 at the Children's Hospital of Pittsburgh (n = 619) were surveyed by questionnaire and their medical records reviewed. Only the men who attempted to conceive a child (n = 387) are included. RESULTS: Logistic regression analysis determined significant risk factors for infertility. Testicular suture was strongly related to infertility (RR, 7.56; 95% CI, 1.66, 34.39) as were bilateral cryptorchidism (RR, 5.51; 95% CI, 1.58, 19.24), varicocele (RR, 4.72; 95% CI, 1.42, 15.75), hormone treatment before surgery (RR, 3.69; 95% CI, 1.22, 11.11), and partner conception problem (RR, 3.32; 95% CI, 1.11, 9.90). CONCLUSIONS: Testicular suture was a potent independent determinant of infertility among formerly cryptorchid men who have orchidopexy. Bilateral cryptorchidism, hormone treatment, varicocele, and partner conception problems also were associated with increased infertility.

How accurate is male recall of reproductive information?

The purpose of this study was to determine how well men recall reproductive information. By using a questionnaire, the authors surveyed men who had undergone orchiopexy for undescended testes and a group of matched control men, all of whom had had surgery at the Children's Hospital of Pittsburgh in Pittsburgh, Pennsylvania (n = 77), and their spouses. Subjects were a random subset of a larger (n = 1,212) male fertility study, which has been ongoing since 1992. In 1994, the spouses of men who participated in the study completed a short telephone survey that contained questions previously asked of their partners. Pearson correlations and kappa statistics were calculated to evaluate the accuracy of male recall of reproductive information. For the continuous measures, such as time to conception and frequency of intercourse, the correlations were high to moderate (r = 0.84 (p < 0.001) and r = 0.45 (p < 0.001), respectively). Agreement between the men and their spouses on the majority of bivariate (yes/no) questions, such as those concerning the use of birth control, as measured by the kappa statistic, was moderate to very good (K ranged from 0.14 to 0.69). Statistics were similar for formerly cryptorchid and control men. Male participants' responses to questions about their reproductive histories were accurate as compared with the responses given by their spouses. In this sample from a large cohort study, men appeared to recall reproductive information with acceptable accuracy.

Correlations among hormone levels, sperm parameters and paternity in formerly unilaterally cryptorchid men.

PURPOSE: We compared characteristics related to fertility between formerly unilaterally cryptorchid men. MATERIALS AND METHODS: We compared sperm counts and gonadotropin levels before and after gonadotropin-releasing hormone stimulation between formerly unilaterally cryptorchid men and controls who had completed a detailed questionnaire on fertility and other pertinent paternity information. These parameters were also compared between the subsets of formerly cryptorchid men who reported paternity and unsuccessful attempts at paternity. RESULTS: Sperm density and total count, and basal and gonadotropin-releasing hormone stimulated follicle-stimulating hormone (FSH) levels were different in the cryptorchidism and control groups. Higher FSH levels and lower sperm counts correlated inversely in the cryptorchidism group, while luteinizing hormone, testosterone and other results of semen analysis did not differ. Furthermore, FSH levels were higher and sperm counts were lower in the subset who reported unsuccessful attempts at paternity compared with those reporting paternity. Other measured parameters did not differ between these groups. CONCLUSIONS: FSH levels are significantly higher and sperm counts are significantly lower in formerly cryptorchid men than in controls. In the cryptorchidism group the same differences are found in fertile and infertile men. Thus, elevated FSH and low sperm counts may be considered risks for infertility in formerly cryptorchid men.

Do men become infertile after having sexually transmitted urethritis? An epidemiologic examination.

OBJECTIVE: To critically assess the possibility that gonorrhea or chlamydia causes male infertility. DESIGN: Comprehensive literature review structured to evaluate the epidemiologic tenets for causality, including biologic plausibility, strength of association, dose response, consistency, temporality, and treatment effect. RESULT(S): It is biologically plausible that gonorrhea and/or chlamydia could cause male infertility. There is clinical and pathologic evidence linking these pathogens to urethritis, linking urethritis to epididymo-orchitis, and linking epididymo-orchitis to infertility. Retrospective epidemiologic results also support an association between chlamydia serologies and male infertility, which in most of these small studies does not reach the level of statistical significance. However, there is no consistent epidemiologic evidence that these pathogens alter sperm characteristics. We discuss the methodologic limitations of previous epidemiologic studies and suggest strategies for future research. CONCLUSION(S): Whether gonorrhea and/or chlamydia cause male infertility is currently unclear. Sound methodologic research strategies must be applied to future studies.

Time to conception after orchidopexy: evidence for subfertility?

OBJECTIVE: To determine whether time to conception is increased among men who were formerly bilaterally or unilaterally cryptorchid compared with a group of matched control men. DESIGN: Retrospective cohort study. SETTING: Human volunteers in an academic research environment. PATIENT(S): Men who underwent orchidopexy between 1955 and 1971 at the Children's Hospital of Pittsburgh (n = 547) and a group of matched control men (n = 463) were surveyed by questionnaire. RESULT(S): Of the men who attempted paternity, the mean time to conception for the bilateral cases, unilateral cases, and control men was 33.90, 11.11, and 8.78 months, respectively. Kaplan-Meier survival analysis showed a significantly longer time to conception among bilateral cases compared with unilateral cases and controls, but not between unilateral cases and control men. Adjustment for confounders and covariates using a Cox Proportional Hazards model showed that former bilaterally cryptorchid men were 68% (95% CI = 55% to 81%) less likely than former unilaterally cryptorchid men or controls to conceive per month of unprotected intercourse. CONCLUSION(S): Time to conception was increased among former bilaterally cryptorchid men compared with both former unilaterally cryptorchid and control men. However, there were no significant differences in time to conception between the unilateral cryptorchid men and the control men.

Paternity after bilateral cryptorchidism. A controlled study.

OBJECTIVE: To compare paternity among men with former bilateral cryptorchidism (referred to as the bilateral group) with a group of men with former unilateral cryptorchidism (referred to as the unilateral group) and a control group. DESIGN: Epidemiologic survey of study cohort. SETTING: Large urban pediatric hospital. SUBJECTS: Men with former bilateral and unilateral cryptorchidism who underwent orchiopexy between 1955 and 1971 at the Children's Hospital of Pittsburgh, Pittsburgh, Pa, and a group of control men have been surveyed by questionnaire concerning paternity and factors related to paternity. MAIN OUTCOME MEASURE: Paternity. RESULTS: Among the married men who had bilateral cryptorchidism, 50% had fathered children, compared with 76% in the control group and 74% in the unilateral group. Data were similar when the men who were cohabitating were included with the married men. When men who had married and had attempted paternity were evaluated, 62% of the men in the bilateral group had been able to father children compared with 94% of the control group and 89% of the men in the unilateral group. No relationship was noted between the age of orchiopexy or lifestyle factors and paternity. Paternity among all groups was related to female-related infertility factors and to the presence of varicoceles. CONCLUSIONS: Paternity was compromised after bilateral cryptorchidism when compared with men with former unilateral cryptorchidism and a control group. Among the bilateral group, infertility is about 3.5 times as frequent than the unilateral group and more than 6 times as frequent among the control group. No correlation was found between age of orchiopexy and paternity for either group.

Paternity after unilateral cryptorchidism: a controlled study.

OBJECTIVE: To determine if paternity is decreased among formerly unilateral cryptorchid men compared with a control group of men. SUBJECTS AND METHODS: Formerly unilateral cryptorchid men who had orchiopexy between 1955 and 1971 at the Children's Hospital of Pittsburgh and a group of control men have had their medical records reviewed and have been surveyed by questionnaire. RESULTS: Among the men who had ever married and had attempted paternity, significantly more of the unilateral cryptorchid men had been unable to father children (10.5%) than among the control group (5.4%). No difference was found when the groups were compared for the duration of regular intercourse without contraception to conception of their first child. There was no relationship between the age of orchiopexy or lifestyle factors and paternity or between the age of orchiopexy and months of regular unprotected intercourse to conception. Paternity among both groups was related to female-related infertility factors and to the presence of varicoceles. CONCLUSION: When compared with a control group, paternity was compromised after unilateral cryptorchidism. Infertility is about twice as frequent among the unilateral group. There was no evidence of subfertility requiring a longer exposure of regular intercourse without contraception among the fertile subgroup. No correlation was found between age of orchiopexy and paternity.