Semen quality, reproductive hormones and fertility of men operated for hypospadias.

The testicular function of men previously operated for hypospadias has been sparsely investigated. Therefore, we investigated semen quality and reproductive hormones of 92 men with isolated hypospadias (IH) and 20 with hypospadias and additional genital disorders (HAGD) and compared with similar results from young men from the general Danish population. All participants lived the Copenhagen area of Denmark. Additionally, fertility information on 1083 men registered as operated for hypospadias was retrieved from national registries. The semen quality of men with IH did not differ from controls, but was reduced in men with HAGD. Median values for IH and HAGD were, respectively: sperm concentration 52 and 32 million (mill)/mL (p = 0.02), total sperm counts 173 and 101 mill (p = 0.03), motile spermatozoa 70 and 58% (p = 0.007) and morphological normal spermatozoa 9 and 4% (p = 0.004). Men with IH had a slight increase in follicle stimulating hormone and luteinizing hormone levels, whereas men with HAGD had more pronounced disturbances. 24.0% of the 1083 men operated for hypospadias were registered as fathers to at least one child, whereas the corresponding number in the general age-matched population was 29.4% (p < 0.01). In conclusion, the majority of men with IH had normal semen quality, whereas it was reduced for men with HAGD. However, reproductive hormone levels indicated a subtle impairment of testicular function also in men with IH. An observed lower number of fathers among men with hypospadias may be because of psychosocial aspects, sexual dysfunction or reduced semen quality or a combination of these factors. Our results should be reassuring for patients with mild forms of IH and their relatives. They can be informed that hypospadias in such cases is not generally associated with poor semen quality. Particularly among patients with HAGD, several may, however, need fertility treatment to reproduce.

Increased frequency of reproductive health problems among fathers of boys with hypospadias.

BACKGROUND: Some studies have suggested an association between paternal subfertility and hypospadias among their sons, although the association has not been systematically investigated. We therefore compared male reproductive health among a group of fathers of boys with hypospadias and a group of fathers to normal children. METHODS: A total of 64 fathers of boys with hypospadias participated; 349 partners of pregnant women served as a control group. All men delivered a semen sample, had a blood sample drawn, underwent a physical examination and completed a questionnaire. RESULTS: Fathers of boys with hypospadias had a significantly lower median sperm concentration (54.1 x 10(6)/ml) (P = 0.004) and total sperm count (222.0 x 10(6)) (P = 0.009) than the controls (81.2 and 326.0 x 10(6)/ml). In addition, the fathers of boys with hypospadias more often reported to have had disorders in the urogenital system (hypospadias, cryptorchidism and testicular cancer) (11/64) (P < 0.001) than the control group (16/349). No significant differences in waiting time to pregnancy was observed, however, 15% of fathers to boys with hypospadias had received fertility treatment. CONCLUSIONS: Fathers of boys with hypospadias not only have an increased frequency of hypospadias, but also decreased semen quality. Most likely fathers and sons share the same susceptibility genes for reproductive dysfunction, but additional impact of environmental factors cannot be excluded.

Low birth weight and male reproductive function.

Scientific interest in morbidity in children born small for gestational age (SGA) has increased considerably over the last few decades. The elevated risk of cardiovascular and metabolic diseases in adulthood in individuals born SGA has been well documented, whereas data on gonadal development are limited. Prospective studies, case-control investigations and registry surveys show that impaired intrauterine growth increases the risks of congenital hypospadias, cryptorchidism and testicular cancer approximately two- to threefold. Although few studies focus on the effect of intrauterine growth on male pubertal development, testicular hormone production or sperm quality, available evidence points towards a subtle impairment of both Sertoli cell and Leydig cell function. Animal studies support the hypothesis that impaired perinatal growth restriction, depending on the timing, can affect postnatal testis size and function into adulthood. Current human data, however, are often based on highly selected hospital populations and lack precise distinctions between low birth weight, SGA, timing of growth restriction and a differentiation of catch-up growth patterns. Despite the methodological inadequacies of individual study results, the combined evidence from all data leaves little doubt that fetal growth restriction is associated with increased risk of male reproductive health problems, including hypospadias, cryptorchidism and testicular cancer.

Reliability of histo-pathological diagnosis of squamous epithelial changes of the uterine cervix.

The reliability of histological diagnosis of squamous epithelial changes was tested by letting 13 pathologists read 1,001 consecutive cervical biopsies twice. Intra-observer and inter-observer agreement, variance, and deviation of diagnosis were determined. The diagnostic ability showed great individual variation and no significant correlation to experience in pathology. The diagnosis of invasive cancer had a high diagnostic specificity, and the diagnostic sensitivity of the diagnosis of no significant epithelial changes was high too. The reliability of the diagnosis of dysplasia and carcinoma in situ proved unsatisfactory.