Male infertility and cryptorchidism (undescended testis) – Cryptorchidism is the most common anomaly of the male genital system. As we are aware, testis are normally descended into the scrotum in 9th month of pregnancy and therefore cryptorchidism is more common in premature birth children.

Observed in 2-5% of newborn children. At the end of 3rd month testis descend and decrease by 1-2%. In undescended testis, 20% not felt by hand touch and they stay in the abdomen. There are different causes: endocrine (hormonal) disorders, genetics, premature birth etc. For normal descending of testis into the scrotum, normal level of the pituitary gland hormones is a condition. Even there are not much serious disorders in hormonal status of the children with cryptorchidism, hormonal changes in early pregnancy negatively affects descending of the testis.

Results of the survey

Cryptorchidism is 3 times more common in white men than in black men. According to a study held in England, undescended testis is found in 2.7% of the children weighting more than 2500 grams and in 21% of the children weighting less than 2500 grams.

What changes occur in undescended testis?

Changes of the germinal cells (sperm formation). In undescended testis, after a year changes are observed in the germinal (sperm forming) cells and they start to destroy. After 2 years sperm forming cells significantly reduce. In 10-45% of the patients sperm forming cells are totally destroyed. For this reason, timely treatment is required to descend the testis.

Relation to male infertility

Abnormality is observed in men’s sperms with undescended or late descended testes. Absence of testes in the scrotum is observed in 2-5% of the men applied for medical care. 31% of these patients have oligospermia and 42% azoospermia if both testes are absent. There is 35-53% of chance of being a father in men with two undescended testes.

Undescended testis and testicular cancer

Undescended (absent in its normal place) testes are risk factors for the future cancer. Risk of cancer with undescended testes is 3.6-7.4 times more. 2-6% of the men with undescended testes have testicular cancer.

Conclusion

• Undescended testes arise from different reasons, mainly from genetic, hormonal and premature birth causes
• There is a risk of infertility and testicular cancer in case of having undescended testes
• Timely treatment prevents killing of sperm forming cells
• Men with two undescended testes have less chance of being a father
• Trauma: undescended testes are more exposed to trauma as they are squeezed in the abdomen and inguinal canal
• Psychological effect: by growing a child gets to know more and absence of testes has a grave psychological effect on him

Recommendations

The main burden is on the parents. They are recommended to give attention to the testes of the child and check if one or two of them are absent, and see a doctor. Treatment for the infants under a year is not recommended, but if after 12-18 months testes will not descend, they need to see a doctor and seek for treatment. Recommendation of the EAU 2010 (European Association of Urology).