Treatment

The rationale for treatment of cryptorchidism includes the increased risk of infertility and testicular cancer, the need to correct hernias, and decreasing the risk of torsion. It is considered, with the exceptions noted here, that bilateral cryptorchidism is associ ated with infertility if the testes remain undescended beyond puberty. However, it has not been shown clearly that treatment during childhood has any beneficial effect on fertility (113). A meta-analysis revealed that in men with bilateral cryptorchidism treated during childhood, there were similar percentages of subjects with azoospermia and oligospermia (<20 million/mL) regardless of the type or age of treatment.

Furthermore, particularly for boys with unilateral cryptorchidism, it has been questioned whether treatment to bring the testis into a scrotal location influences fertility or modifies the risk of tumor development. The percentages of men with azoospermia or oligospermia have been reported to be similar for men who had surgical, hormonal, or both treatments or no treatment at all (113). In one report, 42% of men who had received no treatment for unilateral undescent had sperm density greater than 20 x 106 (45% had oligospermia and 13% had azoospermia) (114). Evaluations of semen in men with unilateral cryptorchidism suggest that treatment has not made a difference regarding fertility, although it must be realized that treatment in these studies was generally at ages considerably older than is recommended currently.

Although semen analysis may be abnormal, it was unclear until recently whether fertility was decreased for men with a history of unilateral cryptorchidism. As discussed in detail later, recent evidence suggests that when this population is compared to a control population, there is no significant difference in paternity rates (2,115).

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