Cryptorchidism and infertility.

Although the maldescended or dystopic testis is one of the most common congenital anomalies in man, proper treatment remains a subject of much discussion and confusion. Certainly, in light of the previously described findings, the future fertility of the patient with unilateral cryptorchidism, regardless of age of correction, should be a realistic concern. Hormonal treatment should be recognized as a good diagnostic test for defining the retractile testes and should not be considered therapy. The pediatrician or family practitioner should be encouraged to examine the scrotal contents thoroughly in the neonatal period and to document findings. Earlier surgical intervention may benefit these patients since a prolonged extrascrotal location may add further insult to an intrinsic abnormality in the dystopic gonad. The cryptorchid testis may be smaller and have decreased consistency with or without surgery and usually signals significant testicular pathology. Synthesis of androgens and serum concentrations of LH should not be affected; thus, secondary sex characteristics will appear normal. Basal levels of FSH are usually elevated but do not necessarily imply overwhelming testicular damage. Current evidence clearly shows a variable degree of primary intrinsic gonadal dysgenesis with a frequent impairment of fertility in the cryptorchid testis, regardless of the time of treatment. Early surgery may decrease the ultimate loss of testicular function superimposed on the congenital dystrophy, thus diminishing the ultimate loss of effective spermatogenesis.