Abstract
Orchiopexy for congenital cryptorchid testes is recommended between ½ and 1 year of age to preserve testicular germ cell maturation. Early operation is not enough to preserve fertility in 22 and 36% of cases. Aim of this study was to set up a protocol for optional adjuvant hormonal therapy after orchiopexy and thereafter cryopreservation of testicular biopsies from infants with bilateral cryptorchidism and high infertility risk. We included 17 boys with bilateral cryptorchidism, normal FSH, and impaired germ cell number per tubular transverse section (G/T) in testicular biopsies at orchiopexy, 7 months to 3½ years old. Postoperatively, optional adjuvant LHRH (kryptocur®) 0.2 mg/0.1 mL 2× every second day in 16 weeks were offered. Ten boys were applicable for age matching according to parent's choice of treatment regime and G/T. Five of them had kryptocur®, and five were controls. Repeat bilateral testicular biopsy evaluation and cryopreservation were offered to all boys 12 months after primary orchiopexy. For cryopreservation, tissue pieces were incubated with a cryoprotectant with a slow program freezing. Two out of five kryptorcur®-treated boys normalized both the average G/T and the number of adult dark spermatogonia (Ad-S). Another kryptocur®-treated boy with initial low G/T and no Ad-S increased the G/T and achieved normal number of Ad-S at time of cryopreservation. In the control group, two patients reached only normal lower range regarding the G/T and the number of Ad-S. None of boys with less than average 0.2 G/T improved significantly, whether they were kryptocur®-treated or not. Based on literature and the present results, we recommend adjuvant LHRH treatment to boys with cryptorchidism and insufficient genuine gonadotropin stimulation at time of surgery, as these patients have high infertility risk. Cryopreservation should be an option in case of treatment failure of adjuvant LHRH. However, to avoid repeat surgery with biopsy, some parents may choose biopsy for cryopreservation at time of the initial bilateral orchiopexy, well informed that the procedure may only be truly indicated in 22 and 36% of the cases.
Highlights
Today, orchiopexy for congenital cryptorchid testes is recommended within the first 1⁄2–1 year of life to preserve testicular germ cell maturation [1,2,3,4]
There were no differences between the two groups in respect of age (p = 0.92), inhibin-B level (p = 0.69), and the average germ cell count per tubular transverse section (p = 0.40) (Figure 1)
Since 2/5 of LHRH-treated patients responded, adjuvant LHRH treatment to cryptorchid boys with insufficient genuine gonadotropin stimulation or in patients with low germ cell count or number of adult dark spermatogonia (Ad-S) by testicular biopsy should be instituted at time of surgery
Summary
Orchiopexy for congenital cryptorchid testes is recommended within the first 1⁄2–1 year of life to preserve testicular germ cell maturation [1,2,3,4]. In accordance with the strategy of early operation follow-up studies on adult men operated for cryptorchidism in childhood have shown significant improvement of fertility even in bilateral cases [5,6,7]. These studies have not conclusively proven that early surgery will protect from azoospermia development. Germ cell hypoplasia in both testes of prepubertal boys with cryptorchidism at time of orchiopexy generally leads to infertility in adulthood [12]
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