Fertility in men with congenital adrenal hyperplasia can be impaired. Testicular tumors are the most frequent cause of impaired fertility. They arise from aberrant adrenal cells in the testes that are stimulated by ACTH. Their location adjacent to the mediastinum and their steroid-producing properties may interfere with spermatogen-esis and Leydig cell function. Secondary hypogonadotropism is a second cause of impaired fertility, resulting from suppression of the hypothalamic-pituitary-gonadal axis by adrenal androgen excess or by production of steroids by testicular tumors. Other testicular abnormalities and psychological factors may also contribute to impaired fertility.

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