Background: Cryptorchidism is a failure of the testis to descend into the scrotum from its initial site of development in the abdomen. The failure of the testis to descend results in significant histologic changes to the testicular tissues and increases risk for infertility and testicular cancer. Incidence of cryptorchidism is approximately 3% at birth declining to 1% at one year of age because of spontaneous descent. Little to no spontaneous descent occurs after six months of age and surgical correction by orchiopexy is recommended by age one to two.
Study Cohort: The Childrens Hospital of Pittsburgh Male Fertility Study has been looking at the impact of cryptorchidism on male fertility since 1992. The study cohort comprises 1405 former cryptorchids and control men. Each of the subjects completed an extensive questionnaire that included questions on marriage and cohabitation, paternity, health problems, and environmental/occupational exposures. A subset of the full cohort returned in adulthood for evaluation of hormone levels and semen analysis (n=167).
Results: The articles presented here represent a selection of the study results looking at time to conception among formerly cryptorchid men, the impact of testicular suture on fertility, and the influence of age at orchiopexy on hormone levels and sperm count. Time to conception is significantly increased among formerly bilateral (33.9 months), but not unilateral cryptorchid men (11.1 months) as compared to control men (8.8 months). Placement of a transparenchymal suture during orchiopexy greatly increases the risk of infertility (RR 7.56) among formerly cryptorchid men. Age at orchiopexy is significantly negatively correlated (r= -0.274) with inhibin B and positively correlated (r=0.229) with FSH.
Conclusions: Cryptorchidism negatively impacts fertility in the human male. It can increase time to conception and reduce sperm counts, especially among formerly bilateral cryptorchid men. Surgical technique utilizing placement of a suture through the testis can greatly increase risk for future infertility and should be avoided. With an incidence of 3% at birth and a prevalence of 1% at one year, it represents the single most common birth defect among human males. Cryptorchidism is of public health importance because it leads to significantly increased risks for both testicular cancer and infertility. Future research should focus on identifying environmental and behavioral causes of cryptorchidism and on optimizing treatment.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-12092004-235945 |
| Date | 04 January 2005 |
| Creators | Coughlin, Michael T. |
| Contributors | Roberta B. Ness, MD, MPH, Ronald E. LaPorte, PhD, MS(Hyg), Peter A. Lee, MD, PhD, Steven H. Belle, PhD, MS(Hyg) |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-12092004-235945/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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