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Delayed treatment of undescended testes may promote hypogonadism and infertility

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Abstract

Context

Undescended testes at birth may be caused by testosterone deficiency during fetal development. It is unclear whether the process of failed descent contributes to permanent endocrine impairment.

Objectives

To evaluate the impact of age at treatment of undescended testes on endocrine and spermatogenic testicular function in middle-aged men.

Patients and methods

Reproductive hormone and semen data of 357 men with previously undescended testes were evaluated with respect to age at correction of testicular position and compared to those of 709 controls with eutopic testes at birth and normozoospermia.

Results

Men with undescended testes had higher mean Luteinizing Hormone levels (p < 0.0001) and lower mean testosterone levels (p = 0.003) compared to controls. They also had lower bi-testicular volumes, higher Follicle Stimulating Hormone levels, and lower sperm concentrations (all p < 0.0001). Lowest mean sperm concentrations were found in subjects with bilateral undescended testes. Normal sperm concentrations were found in 21 % of cases (in 27 % of men with unilateral and in 12 % with bilateral undescended testes), while oligozoospermia was diagnosed in 44 %, and azoospermia in 35 % (in 28 % with unilateral, 46 % with bilateral undescended testes). Subjects with reduced semen quality had higher gonadotropin levels than those with normozoospermia. Age at correction (median: 6 years (1–39)) was inversely correlated with bi-testicular volumes and sperm concentrations, and positively correlated with FSH and LH, but not with serum testosterone.

Conclusion

Latent, rarely decompensated hypogonadism is a potential long-term consequence of undescended testes, besides infertility and testicular cancer, preferentially affecting subjects with delayed or unsuccessful correction of testicular position. Impaired Leydig cell function is likely to contribute to compromised fertility. These observations support correction of cryptorchidism during early infancy.

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Acknowledgments

We thank the technical staff: Sabine Forsthoff for hormone analyses, and Raphaele Kürten, Daniela Hanke, Sabine Rehr, Jolanta Körber for semen analyses and Susan Nieschlag M.A. for language editing of the manuscript. We thank Manuela Simoni for her support of this project and Frank Tüttelmann for database support.

Funding

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector. A. Luberto received an educational grant from her home institution, the University of Modena.

Author Contributions

JR designed the study, was involved in patient care, assembled data, performed data evaluation and drafted the manuscript. AL assembled data, contributed to data evaluation and drafting of the manuscript. EN was the head of the institution until 2008, was involved in patient management and edited the manuscript. MZ designed the study, was involved in patient care and edited the manuscript. SK is the head of the department since 2008, initiated the study, was involved in patient management and edited the manuscript.

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Authors and Affiliations

  1. Center of Reproductive Medicine and Andrology, Department of Clinical Andrology, University of Muenster, Albert-Schweitzer-Campus 1, Building D11, D-48149, Muenster, Germany

    Julia Rohayem, Alessandra Luberto, Eberhard Nieschlag, Michael Zitzmann & Sabine Kliesch

  2. Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Università, 4, 41121, Modena, MO, Italy

    Alessandra Luberto

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  1. Julia Rohayem
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Correspondence to Sabine Kliesch.

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Rohayem, J., Luberto, A., Nieschlag, E. et al. Delayed treatment of undescended testes may promote hypogonadism and infertility. Endocrine 55, 914–924 (2017). https://doi.org/10.1007/s12020-016-1178-0

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