Simone Hildorf1, Erik Clasen-Linde2, Dina Cortes3,4, Magdalena Fossum1,3, Jorgen Thorup1,3. 1. Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. 2. Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. 3. Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. 4. Section of Endocrinology, Department of Pediatrics, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Abstract
PURPOSE: One of the concerns surrounding cryptorchidism is the risk of impaired fertility. Current guidelines recommend orchiopexy at age 6 to 12 months to optimize fertility outcome. We evaluated the fertility potential of boys with nonsyndromic cryptorchidism who underwent orchiopexy within the recommended age range to clarify the need for eventual supplemental treatment modalities. MATERIALS AND METHODS: We retrospectively evaluated mini-puberty hormones (follicle-stimulating hormone, luteinizing hormone and inhibin B) and testicular biopsies from boys with cryptorchidism who underwent orchiopexy within the first year of life between 2010 and 2019. We histologically analyzed germ cell number and type A dark spermatogonia number per seminiferous tubule cross-section in relation to normal values. RESULTS: Of the 333 boys with nonsyndromic cryptorchidism 83 (25%, 21% with bilateral cryptorchidism) had a reduced number of germ cells. A total of 70 boys (21%) had low serum inhibin B, of whom 32 (46%) had a decreased number of germ cells and 23 (33%) had a decreased number of type A dark spermatogonia (p <0.01). Overall, 75 boys (23%) had no type A dark spermatogonia present. CONCLUSIONS: Despite early and successful orchiopexy, 20% to 25% of boys with cryptorchidism may be at risk for infertility based on hormonal and histological data. Blood test and testicular biopsy are mandatory to identify boys at high risk for infertility, in whom additional treatment modalities and followup may be needed.
PURPOSE: One of the concerns surrounding cryptorchidism is the risk of impaired fertility. Current guidelines recommend orchiopexy at age 6 to 12 months to optimize fertility outcome. We evaluated the fertility potential of boys with nonsyndromic cryptorchidism who underwent orchiopexy within the recommended age range to clarify the need for eventual supplemental treatment modalities. MATERIALS AND METHODS: We retrospectively evaluated mini-puberty hormones (follicle-stimulating hormone, luteinizing hormone and inhibin B) and testicular biopsies from boys with cryptorchidism who underwent orchiopexy within the first year of life between 2010 and 2019. We histologically analyzed germ cell number and type A dark spermatogonia number per seminiferous tubule cross-section in relation to normal values. RESULTS: Of the 333 boys with nonsyndromic cryptorchidism 83 (25%, 21% with bilateral cryptorchidism) had a reduced number of germ cells. A total of 70 boys (21%) had low serum inhibin B, of whom 32 (46%) had a decreased number of germ cells and 23 (33%) had a decreased number of type A dark spermatogonia (p <0.01). Overall, 75 boys (23%) had no type A dark spermatogonia present. CONCLUSIONS: Despite early and successful orchiopexy, 20% to 25% of boys with cryptorchidism may be at risk for infertility based on hormonal and histological data. Blood test and testicular biopsy are mandatory to identify boys at high risk for infertility, in whom additional treatment modalities and followup may be needed.
Authors: F Cargnelutti; A Di Nisio; F Pallotti; M Spaziani; M G Tarsitano; D Paoli; C Foresta Journal: J Endocrinol Invest Date: 2022-03-14 Impact factor: 5.467