Most cases of cryptorchidism are treated with surgery.
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In men, sperm develop in the testes, which are normally located in the scrotum. But in 2 to 4 percent of infant boys, 1 or both testes fails to move into the proper location in the scrotum, a condition called cryptorchidism. Although an undescended testis often moves into the scrotum spontaneously during infancy, sometimes the condition needs to be treated as it could interfere with normal production of sperm after puberty, causing infertility. In most cases, cryptorchidism can be corrected, but occasionally, problems persist into adulthood that might interfere with a man's fertility.
Although the testes don't produce mature sperm until puberty, the organs form during fetal development, beginning at about the 5th week of pregnancy. The testes originate in the fetal abdomen, but a complex process, called testicular descent, moves them into the scrotum, where they are usually located at birth.
Testicular descent begins during the 10th week, when each testis moves lower in the body to a pathway between the abdomen and scrotum, called the inguinal canal. Next, each testis moves through this canal into the scrotum, where the temperature after birth will be about 2 degrees Fahrenheit lower than in the abdomen.
Sperm development, or spermatogenesis, requires this reduced temperature. If one or both testes remains in the abdomen at birth, the condition is called cryptorchidism, or cryptorchism. At puberty, if a testis is still in the abdomen, no sperm can develop in that testis, a possible cause of a low sperm count and infertility.
Cryptorchidism is usually detected in a newborn boy as part of a routine examination by a doctor. If both testes remain in the abdomen and the condition is not corrected, 100 percent of patients fail to produce sperm after puberty and are infertile and unable to father children, according to statistics published in a review of cryptorchidism published in "Swiss Medical Weekly" in August 2008. The study also stated the risk of infertility remains at about 38 percent in these men if the condition was corrected when they were children. The study also reported that, if only 1 testis was undescended at birth and the condition was successfully corrected, about 90 percent of these boys have normal fertility as adults.
Treatment and Timing
Most cases of cryptorchidism are diagnosed at or just after birth. The usual treatment is a corrective surgery called orchiopexy, in which the testis is manipulated into the scrotum and stitched in place through a small incision. When surgery is performed, sperm develop after puberty and their numbers may be normal, especially if only 1 tesis is involved. However, in a landmark paper published in October, 2001 in "The Lancet," researchers found that, in men whose condition was corrected but who had heat-induced damage before surgery to primitive cells destined to become sperm, the likelihood of infertility was greater than in similar subjects with normal primitive cells.
Today, most doctors recommend performing corrective surgery early, usually before a baby is 1 year old and often between 3 and 6 months of age. In most cases, surgery is effective in keeping the testis in the scrotum, although doctors sometimes recommend additional treatment with pituitary or testicular hormones.
In some boys who have early corrective surgery for cryptorchidism, infertility still develops, although the reasons for this are not well understood. Some research suggests that, because the testis remains in the abdomen until surgery is performed, this may trigger an autoimmune response, leading to production of anti-sperm antibodies that could harm sperm and contribute to infertility.
The presence of these antibodies was first identified in a paper published in November 1998 in "The Journal of Urology" in which researchers found anti-sperm antibodies in about 14 percent of young boys who had surgery to correct cryptorchidism up to 2 years earlier. After long-term follow-up, 4 of 29 antibody-positive subjects, or about 13 percent, still had these antibodies when they entered puberty. Subsequent studies confirmed that cryptorchidism may cause an autoimmune response against sperm, but more research is needed to determine if this related to infertility in previously cryptorchid men.