The Doctor’s Column - SUMMER 2011

The Doctor’s Column

Q: I had surgery for an undescended testicle when I was five years old. I am now 23 and I have heard that being born with this condition may impair one’s fertility. What are my risks of having difficulty conceiving? Are there any tests I should undergo? What are my options if it turns out I may have a problem?

A: Dr. Victor Chow: Between 3 and 4% of boys are born with cryptorchidism, the medical term for an undescended testicle. In most cases only one testicle has not descended in the scrotum, but some boys are born with both testicles undescended. This problem often corrects itself spontaneously so that only 1% of boys still have the condition by the time they are one year old. If the problem persists after the boy’s first birthday, the testicle will likely not descend on its own later on.

In the latter case, surgery is the best solution, and the sooner it is performed, the better. The surgery should definitely be performed before the child reaches puberty to minimize fertility-related risks. The higher the testicle is lodged in the abdomen, the higher the risks that fertility will be impaired. The risks of adverse effects on fertility are also higher in cases of bilateral cryptorchidism. Generally, fertility rates remain quite good when only one testicle was undescended. However, it may take a bit more time to conceive, therefore I would recommend that you do not wait too long to begin planning your family.

The most frequent possible adverse outcome of cryptorchidism is a lower sperm count as an adult (since body temperature in the abdomen is higher than in the scrotum). Basically, not much can be done about a low sperm count, so we usually do not recommend undergoing any tests before a man is ready to start his family. If it is important for you to know sooner rather than later whether you may be at risk, you could have your sperm count checked. Another possibility is to have your FSH hormone level tested, which gives a good idea of testicular function.

Should there be such a problem as a low sperm count, assisted reproduction techniques such as IVF with ICSI (injection of a single sperm into the egg) or insemination (a procedure which always uses concentrated sperm for maximum efficiency) are options available to you.

And just as important, if not more so, is that you regularly perform a self-examination of your testicles to detect any lump, as cryptorchidism raises the risk of testicular cancer. Fortunately, this type of cancer is highly treatable when caught early.

Dear reader, this page belongs to you! Send your question/s to: info@iaac.ca on IAAC’s website (www.iaac.ca) and one of our specialists will answer. Of course, this column cannot replace a medical consultation and doctors may not be able to answer questions which are too complex or specific, but you are sure to find valuable advice here. We have asked Dr. Victor Chow to host this second The Doctor’s Column. Dr. Chow is a urologist [bio to be completed]