Evaluation of men with unilateral or bilateral undescended testes: Does age of correction make a difference?

Abstract

Objective: It is well documented that patients with undescended testes (UDT) have defects in spermatogenesis and abnormal testicular histology. In this investigation, we reviewed seminal fluid findings and hormone levels in men with bilateral and unilateral undescended testes. With this report, we substantially expand an earlier, smaller series, and confirm trends identified in that pilot study. Design: Retrospective review of data from 4 geographically separate (2 U.S., 1 Egyptian, 1 European) sites including clinical and physical findings, FSH, testosterone, and LH levels. In addition to stratifying based on unilateral versus bilateral cryptorchidism, patients were also categorized based on the age of correction. Materials and Methods: Four institutions were involved in collecting data on men presenting to the andrology clinics with a history of cryptorchidism. Once identified, charts were retrospectively reviewed and analyzed according to the patients’ physical examination, endocrine evaluation, and semen analysis. Results: Ninety-two men were identified with a history of undescended testes, 32 of which had bilateral cryptorchidism. Fifteen of 32 men with bilateral UDT were azoospermic as compared to 26/60 with unilateral UDT. In addition, only 2 men with bilateral UDT had sperm counts 20 million/cc or greater as compared to 11 men with unilateral disease. Regarding patients with bilateral UDT, the average age of correction was 8.0 years and 6 did not undergo surgical correction. The average sperm count of patients with oligospermia was 4.3 million/cc. The average age at correction for those with oligospermia was 6.5 years as compared to 9.5 years for those with azoospermia. When the age of correction was limited to 9–13 years, the average sperm count was 7.5 million/cc. Of interest, we noted a bimodal distribution of sperm with sperm present when the age of correction was up to age 3 years, and then a second peak from 9–13 years. No patient with bilateral UDT had sperm in the ejaculate when corrected after 13 years of age. Conclusions: Testicular dysfunction and impaired spermatogenesis is known to be associated with cryptorchidism. Historically, dysfunction has been noted to occur even before one year of age and increases with increasing age of correction, testicular location, and the presence of bilateralism. We have found that even when corrected peripubertally, sperm may be present in the ejaculate of men with bilateral undescended testes. Interestingly, we also found a bimodal distribution of sperm present in the ejaculate of those corrected before 5 years and then again in the men corrected between the ages of 9–13 years. Although men with former bilateral cryptorchidism have significantly compromised fertility, sperm may still be present and paternity is possible either with or without assisted reproductive techniques.