Cryptorchidism and Its Impact on Male Fertility

Q: Cryptorchidism and Its Impact on Male Fertility

Anonymous： Hello. <br>1. <br>If the right testicle is functioning normally, it can produce sperm. <br>However, if it cannot transport the sperm, the sperm will be naturally reabsorbed. <br>Male hormones, like sperm, can be produced as long as the testicular function is normal. <b

Cryptorchidism with epididymal separation?

Hello Dr.
Hsu, during the newborn examination, both testicles were found to be undescended.
The left testicle occasionally descends into the scrotum when exposed to higher temperatures.
The physician assessed that the right testicle is unlikely to descend on its own after one year of age, so a right orchidopexy was performed when the child was 7 months old.
However, during the procedure, the physician explained that the child's epididymis and testicle were not connected, which would affect the pathway for sperm transport, although hormone secretion would not be impacted.
I would like to ask Dr.
Hsu a few questions, thank you.
(1) Will the right testicle still produce sperm in the future, but with reduced fertility, relying solely on assisted reproductive techniques? Or will it not produce sperm at all and undergo atrophy? Is hormone secretion unaffected? (2) When can we start monitoring the sperm production capability of the right testicle? (3) Are there any methods to determine in advance if the left testicle has similar issues? Thank you!

Niming, 30~39 year old female. Ask Date: 2013/05/21

Dr. Xu Weikai reply Urology

Anonymous: Hello.
1.
If the right testicle is functioning normally, it can produce sperm.
However, if it cannot transport the sperm, the sperm will be naturally reabsorbed.
Male hormones, like sperm, can be produced as long as the testicular function is normal.
Note: This is similar to men who have undergone a vasectomy.
2.
Regarding the reproductive capacity of the right testicle??? I think we can only indirectly assess it by observing the development of the testicle, such as size, elasticity, etc.
Testing cannot specifically target the right testicle.
If a determination is necessary, a biopsy of the right testicle may be needed to check for normalcy; however, this is an invasive procedure and is rarely performed.
3.
As for the left testicle, similar to the right, specific testing cannot be done on one side.
If there is concern about the epididymis being blocked, imaging studies can be conducted: a contrast agent is injected into the corresponding area, followed by radiological examination to check for patency.
However, this is also rarely done and is mostly used for follow-up after vasectomy reversal surgery.
If there are any unclear points, feel free to ask again, and we can discuss and research further.
Online responses should only serve as a reference; if necessary, it is important to seek medical care at a healthcare facility.
This response is provided by Dr.
Hsu Wei-Kai, Director of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2013/05/21

More Info

Cryptorchidism, or undescended testicles, is a condition where one or both testicles fail to move down into the scrotum before birth. This condition can have significant implications for male fertility, particularly if not addressed in a timely manner. In your case, it appears that the right testicle was surgically fixed at 7 months of age, while the left testicle has shown some mobility but remains a concern. Let’s address your questions in detail.

1. Sperm Production and Fertility Potential: The ability of the right testicle to produce sperm after surgical intervention largely depends on the extent of the condition and any associated anatomical issues. If the testicle is functional and has been properly positioned, it may still produce sperm, although the quality and quantity may be affected. The fact that the epididymis (the tube where sperm matures) was not connected to the testicle raises concerns about sperm transport, which could hinder natural conception. However, if the testicle remains viable, it may still produce sperm, albeit potentially at a reduced capacity. Hormonal secretion, particularly testosterone, is often preserved in cases of cryptorchidism, especially if the testicle is brought down into the scrotum, as the blood supply and nerve connections are typically intact.

2. Monitoring Sperm Production: It is advisable to begin monitoring the sperm production capability of the right testicle during puberty, around ages 12 to 14, when hormonal changes lead to increased sperm production. A semen analysis can be performed to assess sperm count, motility, and morphology. This analysis will provide insight into the testicle's functional capacity and help determine if assisted reproductive technologies (ART) might be necessary in the future.

3. Assessing the Left Testicle: To evaluate whether the left testicle has similar issues, a physical examination by a pediatric urologist is essential. They may also recommend imaging studies, such as an ultrasound, to assess the position and structure of the left testicle and its associated structures. Hormonal evaluations can also be performed to check for any abnormalities in testosterone levels, which may indicate issues with testicular function.

In summary, while the right testicle may still produce sperm, its ability to contribute to natural conception could be compromised due to the anatomical issues you mentioned. Hormonal function is likely preserved, which is a positive sign. Regular monitoring and assessments during puberty will be crucial in determining the fertility potential of both testicles. If there are concerns about the left testicle, proactive evaluations can help identify any issues early on. Consulting with a specialist in pediatric urology or reproductive endocrinology can provide tailored guidance and management options as your child grows.

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